Orthostatic Hypotension and Adverse Outcomes in Prefrail and Frail Older Adults: The Potential Role of Anticholinergic Burden.

OBJECTIVES

Anticholinergic medications may exacerbate orthostatic blood pressure dysregulation in frail older adults. We aimed to investigate the association between anticholinergic burden (ACB) and orthostatic hypotension (OH)-related adverse clinical outcomes in prefrail and frail older adults.

DESIGN

A cross-sectional analysis.

SETTING AND

PARTICIPANTS

Community-dwelling older adults aged ≥65 years, totaling 1465 individuals, undergoing comprehensive geriatric assessment.

METHODS

Frailty was defined using the Fried phenotype. ACB was quantified using the Anticholinergic Cognitive Burden Scale and categorized as absent (ACB = 0) or present (ACB ≥1). OH was defined as a ≥20 mm Hg systolic or ≥10 mm Hg diastolic blood pressure reduction within 3 minutes of standing. Among individuals with OH (n = 181), associations between ACB and adverse outcomes (falls, fractures, injuries, depressive symptoms, cognitive impairment, and dependency) were examined separately in prefrail and frail groups.

RESULTS

OH prevalence increased progressively across frailty stages (robust 6.6%, prefrail 12.1%, frail 14.5%; P = .03). In prefrail individuals with OH, ACB ≥1 was independently associated with dependency (odds ratio [OR], 3.50; 95% CI, 1.30-9.41; P = .01). In frail individuals with OH, ACB ≥1 was independently associated with falls (OR, 2.39; 95% CI, 1.13-5.05; P = .02) and cognitive impairment (OR, 3.63; 95% CI, 1.63-8.07; P = .002). These associations remained consistent in sensitivity analyses.

CONCLUSIONS AND IMPLICATIONS: ACB is linked to frailty-stage-specific adverse outcomes in older adults with OH and may be associated with dependency in prefrailty as well as falls and cognitive impairment in frailty. Incorporating ACB assessment into medication review strategies may represent a modifiable target for mitigating vulnerability in older adults with OH.