Risks associated with anticholinergic burden among older people are well established; however, the nature of associations for those specifically living with frailty are not.

This review highlights that in older people with frailty, limited observational evidence indicates associations with reduced ability for chair standing, slower gait speeds, poorer physical performance, increased risk of falls and mortality.

Conflicting associations were reported for outcomes such as grip strength and cognition. No associations were observed for outcomes such as transitions between frailty states or change in psychological wellbeing.

Few studies within this review stratified by frailty grade, with no clear evidence of differential effects of anticholinergics by frailty.

There is a deficiency of studies investigating anticholinergic exposure with a frailty focus. Further research is needed to better inform the use of anticholinergics among older people living with frailty.