Association between anticholinergic and sedative medications and physical functioning: data from the Canadian
Keren Pelen1,2, Patrick Boissy1,2, Karina Lebel2,3,4
1Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC, Canada.
European Journal of Clinical Pharmacology
|May 7, 2026
Summary
Cumulative anticholinergic and sedative medication use negatively impacts physical function in adults aged 45 and older. Higher medication burden, measured by the Drug Burden Index (DBI), is linked to poorer performance in mobility and balance tests.
Area of Science:
- Gerontology
- Pharmacology
- Public Health
Background:
- Cumulative exposure to anticholinergic and sedative medications is a growing concern for older adults' health.
- These medications can impair cognitive and physical functions, leading to adverse health outcomes.
- Understanding the specific impact on physical functioning is crucial for preventative strategies.
Purpose of the Study:
- To determine which physical function attributes are most affected by anticholinergic and sedative medication use.
- To investigate these impacts across two distinct age groups: 45-64 years and 65-85 years.
Main Methods:
- Analysis of baseline data from 30,097 community-living Canadians.
- Quantification of medication use using the Drug Burden Index (DBI).
- Assessment of physical functioning through timed walk, Timed Up and Go (TUG), balance, chair rise, and grip strength tests.
Main Results:
- A higher DBI score (≥1) was significantly associated with reduced physical functioning, particularly in the TUG test.
- Poorer physical functioning profiles were linked to increased exposure to medications (DBI 0
- These associations were consistent across both middle-aged (45-64) and older adult (65-85) groups.
Conclusions:
- Cumulative anticholinergic and sedative medication burden is inversely associated with physical functioning in adults aged 45 and older.
- The findings highlight the importance of monitoring medication burden to preserve physical function across different adult age groups.
- These results underscore the need for medication reviews to mitigate risks associated with polypharmacy.
Related Concept Videos
01:30Indirect-Acting Cholinergic Agonists: Pharmacological Actions
Indirect-acting cholinergic agonists, also known as anticholinesterases, exert their pharmacological effects by enhancing cholinergic transmission in various body parts, including the neuromuscular junction, autonomic cholinergic synapses, and the brain.
At the neuromuscular junction, these agents work by inhibiting the breakdown of acetylcholine, allowing it to remain bound to the receptor and bind to nearby receptors. This process leads to repetitive firing of the endplate, causing muscle...
At the neuromuscular junction, these agents work by inhibiting the breakdown of acetylcholine, allowing it to remain bound to the receptor and bind to nearby receptors. This process leads to repetitive firing of the endplate, causing muscle...
01:27Pharmacodynamics in Geriatric Patients: Effects of Age
Age-related pharmacokinetic changes are extensively documented, but understanding age-related pharmacodynamic alterations is relatively limited. This knowledge gap can be partly attributed to the complexity of developing appropriate measures of drug responses compared to bioanalytical methods for determining drug concentrations.Most information regarding age-related differences in human pharmacodynamics originates from cross-sectional studies. However, these studies assume that observed mean...
01:24Cholinergic Antagonists: Pharmacokinetics
Cholinergic antagonists—such as antimuscarinics—are available in oral, topical, ocular, parenteral, and inhalational formulations. Most antimuscarinics are oral formulations, while scopolamine is available as a topical patch, and ipratropium and tiotropium are available as inhalation aerosols or powders. Atropine, tropicamide, and cyclopentolate are topically instilled in the eye. Most antimuscarinics are lipid-soluble and readily absorbed from the gastrointestinal tract and the conjunctiva.
01:28Cholinergic Antagonists: Pharmacological Actions
Antimuscarinic drugs block muscarinic receptors in multiple systems, including the gut, eye, smooth muscles, respiratory tract, cardiovascular, and central nervous systems. They produce similar effects with varying selectivity depending on the specific agent and tissue. Here are the key pharmacological actions of antimuscarinics:
Gastrointestinal Effects: Antimuscarinics reduce gut contractions, increase gastric emptying, and slow intestinal transit. They partly inhibit gastric acid secretion...
Gastrointestinal Effects: Antimuscarinics reduce gut contractions, increase gastric emptying, and slow intestinal transit. They partly inhibit gastric acid secretion...
01:21Skeletal Muscle Relaxants: Adverse Effects
Skeletal muscle relaxants are widely used for muscle paralysis and relieving pain following any muscle injury or stiffness. However, depending on the drug type, they can have adverse effects that range from mild to severe. Usually, nondepolarizing neuromuscular blockers have minimal side effects. For example, drugs like d-tubocurarine, cisatracurium, and rocuronium cause hypotension, whereas drugs like baclofen, when stopped abruptly, can lead to the recurrence of spastic conditions.
Unlike...
Unlike...
01:15Drug Dosing: Geriatric Patients
Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...