Low-Income Older Adults' Vulnerability to Anticholinergic Medication-Associated Frailty

Area of Science:

• Gerontology
• Pharmacology
• Psychometrics

Background:

• Growing evidence links anticholinergic drug burden to physical frailty.
• Prior research predominantly featured white populations, limiting generalizability.
• This study assessed anticholinergic burden tools in a diverse cohort of older adults.

Purpose of the Study:

• To investigate the association between anticholinergic drug exposure and frailty in a diverse population.
• To compare the measurement function and reliability of five anticholinergic burden tools.
• To evaluate the predictive performance of these tools for frailty status.

Main Methods:

• A psychometric approach assessed five tools: ACB, ADS, average daily dose, TSDD, and CAB.
• Spearman correlation and ICC determined tool associations.
• Ordinal logistic regression and AUC evaluated prediction of frailty.

Main Results:

• The cohort comprised 80 older adults (71% African American).
• All five anticholinergic burden tools showed high correlation (p < 0.001) and reliability (ICC3 0.66).
• Tools accurately predicted prefrail and frail status (AUC range 0.78-0.85).

Conclusions:

• Anticholinergic burden tools are reliable and predictive of frailty in low-income African American older adults.
• Clinicians can confidently use any of the evaluated tools in clinical settings.
• Further research should explore interventions like deprescribing to mitigate frailty.