Increasing prevalence of anticholinergic medication use in older people in England over 20 years: Cognitive Function and Ageing Study I and II

Carlota M. Grossi, Kathryn Richardson, George M. Savva, Chris Fox, Antony Arthur, Yoon K. Loke, Nicholas Steel, Carol Brayne, Fiona E. Matthews, Louise Robinson, Phyo Kyaw Myint, Ian Maidment* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

32 Citations (Scopus)
4 Downloads (Pure)


Anticholinergic medication use is linked with increased cognitive decline, dementia, falls and mortality, and their use should be limited in older people. Here we estimate the prevalence of anticholinergic use in England’s older population in 1991 and 2011, and describe changes in use by participant’s age, sex, cognition and disability.
We compared data from participants aged 65+ years from the Cognitive Function and Ageing Studies (CFAS I and II), collected during 1990–1993 (N = 7635) and 2008–2011 (N = 7762). We estimated the prevalence of potent anticholinergic use (Anticholinergic Cognitive Burden [ACB] score = 3) and average anticholinergic burden (sum of ACB scores), using inverse probability weights standardised to the 2011 UK population. These were stratified by age, sex, Mini-Mental State Examination score, and activities of daily living (ADL) or instrumental ADL (IADL) disability.
Prevalence of potent anticholinergic use increased from 5.7% (95% Confidence Interval [CI] 5.2–6.3%) of the older population in 1990–93 to 9.9% (9.3–10.7%) in 2008–11, adjusted odds ratio of 1.90 (95% CI 1.67–2.16). People with clinically significant cognitive impairment (MMSE [Mini Mental State Examination] 21 or less) were the heaviest users of potent anticholinergics in CFAS II (16.5% [95% CI 12.0–22.3%]). Large increases in the prevalence of the use medication with ‘any’ anticholinergic activity were seen in older people with clinically significant cognitive impairment (53.3% in CFAS I to 71.5% in CFAS II).
Use of potent anticholinergic medications nearly doubled in England’s older population over 20 years with some of the greatest increases amongst those particularly vulnerable to anticholinergic side-effects.
Original languageEnglish
Article number267
Pages (from-to)267
Number of pages8
JournalBMC Geriatrics
Issue number1
Publication statusPublished - 31 Jul 2020

Bibliographical note

We would like to thank the UK Medical Research council CFAS study group for data collection and management. We are also grateful to all respondents, their families and their primary care teams for their participation in the CFAS studies. We thank the CFAS II fieldwork interviewers at Cambridge, Nottingham and Newcastle for their valuable contribution.
This research was supported by funding from Alzheimer’s Society (AS-PG2013-017). The funder had no role in the design, implementation, analysis or interpretation of the study


  • Cognitive impairment
  • Anticholinergic burden


Dive into the research topics of 'Increasing prevalence of anticholinergic medication use in older people in England over 20 years: Cognitive Function and Ageing Study I and II'. Together they form a unique fingerprint.

Cite this