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BMC Geriatr. 2016 Apr 2;16:76. doi: 10.1186/s12877-016-0251-0.

Anticholinergic medication use and falls in postmenopausal women: findings from the women's health initiative cohort study.

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School of Pharmacy, University of Washington, 1959 NE Pacific St, H375G, Box 357630, Seattle, WA, 98195-7630, USA.
Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, 91320, USA.
WHI Clinical Coordinating Center, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA.
Division of Epidemiology, UC San Diego, 9500 Gilman Dr #0725, La Jolla, CA, 92093, USA.
College of Public Health, Department of Epidemiology, University of Iowa, 145 N Riverside Dr, 100 CPHB, Iowa City, IA, 52242, USA.
Department of Epidemiology, University of Pittsburgh, A510 Crabtree Hall, Pittsburgh, PA, 15261, USA.
Departments of Medicine and Nutritional Sciences, University of Arizona Cancer Center, 1515 N Campbell Ave, PO Box 245024, Tucson, AZ, 85724, USA.
School of Pharmacy, University of Washington, 1959 NE Pacific St, H375G, Box 357630, Seattle, WA, 98195-7630, USA.



Results from studies assessing the association between anticholinergic use and falls are mixed, and prior studies are limited in their ability to control for important potential confounders. Thus, we sought to examine the association between anticholinergic medication use, including over-the-counter medications, and recurrent falls in community-dwelling older women.


We analyzed data from a prospective cohort study of women aged 65 to 79 years from the Women's Health Initiative Observational Study and Clinical Trials. Women were recruited between 1993 and 1998, and analyses included 61,451 women with complete information. Medications with moderate or strong anticholinergic effects were ascertained directly from drug containers during face-to-face interviews. The main outcome measure was recurrent falls (≥2 falls in previous year), which was determined from self-report within 1.5 years subsequent to the medication assessment.


At baseline, 11.3 % were using an anticholinergic medication, of which antihistamines (commonly available over-the-counter) were the most common medication class (received by 45.2 % of individuals on anticholinergic medication). Using multivariable GEE models and controlling for potential confounders, the adjusted odds ratio for anticholinergic medication use was 1.51 (95 % CI, 1.43-1.60) for recurrent falls. Participants using multiple anticholinergic medications had a 100 % increase in likelihood of recurrent falls (adjusted odds ratio 2.00, 95 % CI 1.73-2.32). Results were robust to sensitivity analysis.


Anticholinergic medication use was associated with increased risk for recurrent falls. Our findings reinforce judicious use of anticholinergic medications in older women. Public health efforts should emphasize educating older women regarding the risk of using over-the-counter anticholinergics, such as first-generation antihistamines.


Anticholinergic; Community dwelling; Falls; Older adults

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