Analysis of anticholinergic and sedative medicine effects on physical function, cognitive function, appetite and frailty: a cross-sectional study in Australia

BMJ Open. 2019 Sep 4;9(9):e029221. doi: 10.1136/bmjopen-2019-029221.


Objective: To test the association between use of medicines with anticholinergic or sedative properties and physical function, cognitive function, appetite and frailty.

Design, setting and participants: This cross-sectional study analysed baseline data collected as part of the Australian Longitudinal Study of Ageing, a population-based cohort of 2087 participants aged 65 years or over living in South Australia.

Main outcome measures: Physical function was measured at baseline using measures including hand grip strength, walking speed, chair stands, activities of daily living and instrumental activities of daily living (IADL). Cognitive function was measured using Mini-Mental State Examination. Appetite was measured using Center for Epidemiologic Studies Depression question 2. Frailty was measured using frailty index. The association between use of anticholinergics or sedatives and physical or cognitive function, appetite, or frailty was assessed using analysis of covariance and ordinal or binary logistic regression.

Results: Almost half of the population were using anticholinergics or sedatives (n=954, 45.7%). Use of anticholinergics was significantly associated with poorer grip strength, slower walking speed, poorer IADL and poorer appetite. Use of sedatives was significantly associated with poorer grip strength, slower walking speed and poorer IADL. We found no significant association between medicine use and cognitive function. Users of anticholinergics or sedatives were significantly more likely to be frail compared with non-users.

Conclusion: Use of medicines with anticholinergic or sedative properties is significantly associated with poorer physical function, poorer appetite and increased frailty. Early identification of signs and symptoms of deterioration associated with medicine use is particularly important in older people so that worsening frailty and subsequent adverse events are prevented.

Keywords: anticholinergics; frail older adults; sedatives.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living*
  • Aged
  • Aged, 80 and over
  • Appetite / drug effects*
  • Cholinergic Antagonists / adverse effects*
  • Cognition / drug effects*
  • Female
  • Frailty / chemically induced*
  • Humans
  • Hypnotics and Sedatives / adverse effects*
  • Longitudinal Studies
  • Male
  • South Australia
  • Surveys and Questionnaires


  • Cholinergic Antagonists
  • Hypnotics and Sedatives