The Relationship Between Anticholinergic Load and Frailty Status: A Cross-Sectional Study in Elderly Individuals

INTRODUCTION: Frailty is a significant concern in elderly individuals, and the anticholinergic effects of medications are commonly encountered in geriatric patients. This study aims to explore the relationship between anticholinergic drug burden and frailty status in people aged 65 and older.
METHODS: The study included 1,058 individuals identified as "pre-frail" and "frail" according to the Fried frailty index, who visited a geriatric outpatient clinic at a tertiary reference center. All participants underwent a comprehensive geriatric assessment along with socio-demographic data. The anticholinergic load of the medications used by the participants was measured using the Anticholinergic Cognitive Burden Scale (ACB), with ACB scores of ≥2 considered indicative of a high anticholinergic load. The relationship between frailty status and high ACB burden was analyzed using multivariate analysis.
RESULTS: The study consisted of 672 (56.8%) participants classified as "pre-frail" and 386 (32.6%) classified as "frail". Frailty was more prevalent among older individuals, females, those with lower education levels, and unmarried individuals. Additionally, frail individuals exhibited high ACB scores, multi-morbidity, cognitive impairments, and undernutrition. Multivariate analysis revealed that an ACB score of ≥2 was 2.07 times more likely to be associated with frailty (OR: 1.63, 95% CI: 1.43-2.98, p < 0.001).
DISCUSSION AND CONCLUSION: A high ACB score is significantly associated with frailty compared to pre-frailty. Assessing anticholinergic drug load, a modifiable factor, should be considered as it may positively influence the management of frail patients.