Elevated Anticholinergic Use Associated with Accelerated Decline in Mobility and Strength in Older Adults

Recent research from Kaiser Permanente Washington has revealed that greater cumulative exposure to anticholinergic medications correlates with a faster deterioration in gait speed and grip strength among the elderly. The study, titled "Cumulative Anticholinergic Exposure and Change in Gait Speed and Grip Strength in Older Adults," analyzed data from over 4,200 participants enrolled in the Adult Changes in Thought study, spanning from 1994 to 2020.

Anticholinergics are drugs that interfere with acetylcholine, a neurotransmitter vital for memory, muscle activation, and cognitive functions. These medications are commonly prescribed to older adults, but their long-term use has raised concerns due to potential cognitive and physical side effects, including confusion, falls, and notably, declines in muscle performance.

Previous studies suggested minor associations between anticholinergic use and reduced gait speed or grip strength, but these effects were often considered clinically insignificant. However, this comprehensive cohort study employed weighted cumulative exposure models over varying time frames—up to 10 years—to better capture the long-term impact.

The findings indicated that the highest cumulative exposure over four years resulted in measurable declines in gait speed, with a decrease of approximately 0.0034 meters per second per year for each unit increase in standardized exposure. Longer assessment windows, such as six years, also showed significant reductions in grip strength, with an average decline of 0.0329 kilograms per year.

Importantly, the study suggests that ongoing accumulation of small but persistent losses in mobility and strength can become clinically meaningful over time. The authors advise healthcare providers to minimize anticholinergic prescriptions whenever possible, prescribe the lowest effective doses, and regularly reevaluate patients to consider deprescribing strategies.

Given these results, cautious prescribing is recommended to help preserve mobility and strength in older adults and prevent further health deterioration.

For more details, visit the original study published in JAMA Network Open. (Source: https://medicalxpress.com/news/2025-07-higher-anticholinergic-linked-faster-decline.html)