Frail with orthostatic hypotension: any anticholinergic burden was associated with falls and cognitive impairment

Design

Cross-sectional analysis

Population

1465 community-dwelling adults ≥65 (181 with orthostatic hypotension)

Primary outcome

Adverse outcomes by anticholinergic burden in OH, stratified by frailty

Effect

Frail with OH: falls OR 2.39 (1.13 to 5.05); cognitive impairment OR 3.63 (1.63 to 8.07)

A cross-sectional study of 1465 community-dwelling adults aged 65 and over having comprehensive geriatric assessment in Turkey examined anticholinergic burden among the 181 with orthostatic hypotension.

Orthostatic hypotension became more common with frailty (6.6% robust, 12.1% prefrail, 14.5% frail). Among frail people with orthostatic hypotension, an anticholinergic burden score of 1 or more was associated with falls (OR 2.39, 95% CI 1.13 to 5.05) and cognitive impairment (OR 3.63, 1.63 to 8.07). In the prefrail, it was associated with dependency (OR 3.50).

Cross-sectional data cannot show which came first. But the combination is a recognisable, reviewable target: a frail patient who drops their pressure on standing and takes an anticholinergic.

• Calculate anticholinergic burden in every frail patient with orthostatic hypotension.
• Look for bladder antimuscarinics, tricyclics, first-generation antihistamines and some antipsychotics.
• Deprescribe or switch where possible, one drug at a time.
• Recheck lying and standing blood pressure after changes.

Why it matters

It identifies a combination where one modifiable drug class is linked to the outcomes geriatricians most want to prevent.

Don't overread it

Cross-sectional: it cannot show that anticholinergics cause these outcomes or that stopping them helps.

The statistics, in plain English

The subgroups are small — 181 people with orthostatic hypotension split by frailty — so intervals are wide. Odds ratios from cross-sectional data describe association at one time point.

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