Anticholinergic medications (ACMs) are associated with poorer age-related outcomes including falls and frailty. Drug interactions and comorbidities may increase the risk of ACM use in people with HIV (PWH). We investigate the associations of ACM use with falls and frailty among older (>50 years) PWH participating in the POPPY study.
The anticholinergic potential of all co-medications received at POPPY entry was coded using the anticholinergic burden score (ACB), anticholinergic risk score (ARS) and Scottish Intercollegiate Guidelines Network (SIGN) score; drugs scoring ?1 on any of the scales were defined as ACM. Associations with recurrent falls (?2 self-reported falls in 28 days) and frailty (modified Fried’s, ?3 of low grip strength, low gait speed, self-reported exhaustion and low activity) were assessed using univariate and multivariable logistic regression adjusting for 1) demographic/lifestyle factors only, and additionally 2) number of non-ACM co-medications, comorbidities and depressive symptoms (PHQ-9).
The 699 PWH had a median age of 57 years (interquartile range 53-62), 88% were male, 86% White, 60% single and 34% unemployed or sick/disabled. Almost all (692, 99%) were on antiretroviral therapy, 642 (92%) had viral load <50 cps/ml and 607 (89%) CD4>350 cells/mm3. ACM use was reported by 193 (28%) with 64 (9%) on ?2 ACM; commonly prescribed ACM were codeine (12%), citalopram (12%), loperamide (9%), amitriptyline (7%) and diazepam (6%). Those on ACM were more likely to be White (92% vs 84%, p=0.005), single (69% vs 60%, p=0.02), sick/disabled (30% vs 15%, p<0.001) and report recent recreational drug use (31% vs 23%, p=0.05) than non-ACM users. Falls were reported in 63/673 (9%) and 126/609 (21%) met frailty criteria. Those reporting ACM use were more likely to report falls (17% vs 6% in non-ACM users, p<0.001) and frailty (32% vs 17%, p<0.001). Use of ?2 ACMs was associated with an increased odds of falling after adjustment for confounders (demographic/lifestyle factors only: odds ratio 4.53 [95% confidence interval 2.06-9.98]); +clinical factors (3.58 [1.37-9.38]) (Table). Similar, although weaker, associations were seen with frailty (2.26 [1.09-4.70] and 2.12 [0.89-5.0], respectively).
ACM are commonly prescribed for PWH. There is strong evidence for an association between cumulative ACM use and recurrent falls, and to a lesser extent frailty. Clinicians should be alert to this association and reduce ACM exposure where possible.