Use of Medications with Anticholinergic Properties and the Long Term Risk of Hospitalization for Falls and Fractures in the EPIC-Norfolk Longitudinal Cohort Study

Maw Pin Tan*, Guo Jeng Tan, Sumaiyah Mat, Robert N. Luben, Nicholas J. Wareham, Kay-Tee Khaw, Phyo Kyaw Myint

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)
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The consumption of medications with anticholinergic activity has been suggested to result in the adverse effects of mental confusion, visual disturbance and muscle weakness which may lead to falls. Existing published evidence linking anticholinergic drugs with falls, however, remains weak. This study was conducted to evaluate the relationship between anticholinergic cognitive burden (ACB) and the longterm risk of hospitalization with falls and fractures in a large population study. The dataset comprised of information from 25 639 men and women (aged 40-79 years) recruited from 1993-1997 from Norfolk, United Kingdom into the European Prospective Investigation into Cancer (EPIC)-Norfolk study. The time to first hospital admission with a fall with or without fracture was obtained from the National Health Service hospital information system. Cox-proportional hazards analyses were conducted to adjust for confounders and competing risks. Falls hospitalization rate was 5.8% over a median follow-up of ~19.4 years. The unadjusted incidence rate ratio for the use of any drugs with anticholinergic properties was 1.79 (95% CI;1.66-1.93). The hazard ratios (95% CI) for ACB scores of 1, 2 to 3, and ≥4 compared to ACB=0 for falls hospitalization were 1.20 (1.09-1.33), 1.42 (1.25-1.60) and 1.39 (1.21-1.60) after adjustment for age, gender, medical conditions, physical activity, and blood pressure. Medications with anticholinergic activity are associated with an increased risk of subsequent hospitalization with a fall in over a 19-year follow-up period. The biological mechanisms underlying the long term risk of hospitalization with a fall or fracture following baseline ACB exposure remains unclear and requires further evaluation.
Original languageEnglish
Pages (from-to)105-114
Number of pages10
JournalDrugs & Aging
Issue number2
Early online date5 Dec 2019
Publication statusPublished - Feb 2020

Bibliographical note

Acknowledgements: The EPIC-Norfolk study (DOI 10.22025/2019.10.105.00004) has received funding from the Medical Research Council (MR/N003284/1 and MC-UU_12015/1) and Cancer Research UK (C864/A14136). We are grateful to all the participants who have been part of the project and to the many members of the study teams at the University of Cambridge who have enabled this research.

Funding: This work was supported by grants from the Medical Research Council and Cancer Research UK. Funders had no role in study design or interpretation of the findings.


  • accidental falls
  • aged
  • anticholinergics
  • cognition


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