Anticholinergic Burden and Time-to-Death in Older Adults: A Retrospective Cohort Study

Anticholinergic burden is common in older adults and has been associated with adverse outcomes, although its association with mortality is inconsistent. This study aimed to investigate the association between anticholinergic burden and time-to-death in older adults and to examine whether this association differs according to baseline frailty status.

This retrospective cohort study analyzed 2739 adults (65-95 years) who attended a geriatric clinic between 2013 and 2020 and had a documented date of death during the study period. Anticholinergic burden was categorized by anticholinergic cognitive burden (ACB) scale scores as low (0-1) or high (≥ 2). Frailty was defined as a clinical frailty scale (CFS) score ≥ 4. Time-to-death was defined as the interval between the index geriatric visit and death. Subgroup analyses explored frailty, polypharmacy, and major comorbidities.

Among the study population, high ACB was associated with a significantly shorter time-to-death (log-rank p = 0.013). After adjustment for age, sex, and frailty status, high ACB remained independently associated with a higher hazard of death at both 1-year (HR 1.20, 95% CI 1.03-1.40) and 5-year follow-up (HR 1.15, 95% CI 1.05-1.28). In stratified analyses, this association was observed among frail individuals (log-rank p = 0.007), whereas no significant association was observed among non-frail participants (p = 0.767).

Higher anticholinergic burden was independently associated with shorter time-to-death in older adults, with the association predominantly observed in frail individuals. These findings underscore the need for routine frailty and anticholinergic burden assessment in geriatric care and support targeted deprescribing in frail populations.