A recent study published in JAMA Open Network has found that frequent use of anticholinergic drugs, commonly prescribed for conditions such as chronic obstructive pulmonary disease, bladder disorders, and Parkinson’s disease, may contribute to faster physical decline in older adults. These medications work by blocking acetylcholine, a key neurotransmitter involved in nervous system function. Although their sedative and cognitive side effects can be reversed when the drugs are stopped, it remains unclear whether prolonged use results in lasting reductions in physical performance.
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The research examined over 4,000 older adults, tracking changes in their walking speed and grip strength over several years, alongside detailed records of their anticholinergic medication intake from 1994 to 2020. The findings revealed that while grip strength remained largely unaffected, higher cumulative exposure to anticholinergics was associated with a more rapid decline in walking speed. This decline in mobility is particularly concerning, as frailty and changes in gait have been strongly linked to poorer health outcomes, including increased risk of disability and mortality.
Unlike previous studies, which often considered drug exposure at a single point in time, this investigation accounted for variations in dosage, timing, and duration of use over a decade. The researchers emphasised that the accumulation of physical decline due to anticholinergic exposure could become clinically significant over time, highlighting the importance of careful medication management in older populations.
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In light of these findings, the authors recommend that clinicians minimise the prescription of anticholinergic drugs whenever possible, prescribing the lowest effective dose and regularly reviewing patients to identify opportunities for deprescribing. Such measures could help promote healthier ageing and reduce the risk of adverse effects linked to these commonly used medications.
