Anticholinergic Burden, Falls, and the Concept of Appropriate Polypharmacy in Indonesian Geriatric Clinics: A Multicentre Observational Study.

BACKGROUND

A high anticholinergic burden (ACB) scale score (≥3) and polypharmacy have been viewed negatively due to possible adverse events. As Indonesian multicentre data in this field are lacking, this study aimed to provide regional data related to ACB, polypharmacy, and falls, and to analyse factors potentially linked to falls.

METHODS

Data from community-dwelling older adults aged ≥60 years were collected in 12 geriatric care centres through history taking and medical records. Bivariate and multivariate analyses were conducted to evaluate the association between covariates and falls.

RESULTS

Polypharmacy and high ACB (score ≥3) were observed in 43.9% and 1.8% of 626 older adults, respectively. The five most prescribed drug classes were calcium-channel blockers, angiotensin receptor blockers, statins, beta blockers, and proton pump inhibitors. The three most prescribed drugs with possible anticholinergic activity were furosemide, isosorbide dinitrate, and cetirizine. The prevalence of past-year falls was 16.8%. Falls were associated with age ≥80 years (odds ratio [OR] 2.44, 95% confidence interval [CI] 1.31-4.53), female sex (OR 2.08, 95% CI 1.30-3.31), transient ischaemic attack and cerebrovascular accident (OR 1.97, 95% CI 0.94-4.10), multimorbidity (≥3 co-morbidities) (OR 1.80, 95% CI 1.07-3.03), depression (OR 1.79, 95% CI 1.00-3.23), and polypharmacy (OR 0.65, 95% CI 0.40-1.05).

CONCLUSION

The prevalence of a high ACB score and falls were 1.8% and 16.8%, respectively. Approximately one in two older adults had polypharmacy. We observed a non-significant inverse relationship between polypharmacy and falls. This may possibly suggest appropriate polypharmacy and closer monitoring applied in geriatric settings, which requires further investigation.