The Association Between Anticholinergic Medication Burden and Health Related Outcomes in the 'Oldest Old': A Systematic Review of the Literature

Drugs Aging. 2015 Oct;32(10):835-48. doi: 10.1007/s40266-015-0310-9.


Background: Increased exposure to anticholinergic medication is problematic, particularly in those aged 80 years and older.

Objective: The aim of this systematic review was to identify tools used to quantify anticholinergic medication burden and determine the most appropriate tool for use in longitudinal research, conducted in those aged 80 years and older.

Methods: A systematic literature search was conducted across six electronic databases to identify existing tools. Data extraction was conducted independently by two researchers; studies describing the development of each tool were also retrieved and relevant data extracted. An assessment of quality was completed for all studies. Tools were assessed in terms of their measurement of the association between anticholinergic medication burden and a defined set of clinical outcomes, their development and their suitability for use in longitudinal research; the latter was evaluated on the basis of criteria defined as the key attributes of an ideal anticholinergic risk tool.

Results: In total, 807 papers were retrieved, 13 studies were eligible for inclusion and eight tools were identified. Included studies were classed as 'very good' or 'good' following the quality assessment analysis; one study was unclassified. Anticholinergic medication burden as measured in studies was associated with impaired cognitive and physical function, as well as an increased frequency of falls. The Drug Burden Index (DBI) exhibited most of the key attributes of an ideal anticholinergic risk tool.

Conclusion: This review identified the DBI as the most appropriate tool for use in longitudinal research focused on older people and their exposure to anticholinergic medication burden.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Accidental Falls* / statistics & numerical data
  • Aged, 80 and over
  • Cholinergic Antagonists / administration & dosage
  • Cholinergic Antagonists / adverse effects*
  • Cholinergic Antagonists / therapeutic use
  • Cognition Disorders / chemically induced*
  • Databases, Factual
  • Female
  • Humans
  • Male
  • Risk
  • Treatment Outcome


  • Cholinergic Antagonists