Study Links Higher Anticholinergic Use to Mobility Decline in Seniors

A recent study conducted by researchers at Kaiser Permanente Washington has established a significant correlation between higher cumulative exposure to anticholinergic medications and a faster decline in mobility and strength among older adults. The findings, published in the Journal of the American Medical Association (JAMA) Network Open, highlight the urgent need for healthcare providers to reevaluate prescribing practices for these medications in elderly patients.

The study, titled "Cumulative Anticholinergic Exposure and Change in Gait Speed and Grip Strength in Older Adults," involved a cohort of 4,283 participants enrolled in the Adult Changes in Thought study from 1994 to 2020. Participants were required to have at least ten years of continuous enrollment in the health plan and to have undergone a minimum of two study visits where gait speed and grip strength were measured. The average age of participants ranged from 74.3 to 74.5 years, with approximately 58.5% being women.

According to Dr. Shelly L. Gray, the lead author of the study and a researcher at Kaiser Permanente Washington, the results indicate that "higher cumulative anticholinergic use was associated with greater decline rates of gait speed and grip strength, independent of aging and comorbidities" (Gray et al., 2025). The researchers quantified anticholinergic exposure using pharmacy dispensing records, calculating both total and mean standardized daily doses over varying time frames up to ten years. Notably, a four-year weighted cumulative exposure yielded a statistically significant decline in gait speed at a rate of -0.0034 meters per second per year for each unit increase in the weighted mean standardized daily dose.

In terms of grip strength, the study found significant associations only with the six-year weighted cumulative exposure, indicating a decline of -0.0329 kilograms per year per unit increase in the same measure. These findings underscore the accumulating impact of even small declines in mobility and strength, which may become clinically meaningful over time.

Older adults are often prescribed anticholinergic medications, which are known to interfere with acetylcholine, a neurotransmitter critical for cognitive function and muscle activation. Such medications can lead to cognitive fog, confusion, and an increased risk of falls. Despite warnings and emerging evidence linking these drugs to negative health outcomes, the prescribing patterns for anticholinergics have been slow to shift.

Dr. Andrew Zinin, an editorial reviewer of the study and a clinical researcher, noted, "While previous studies suggested a weak correlation between anticholinergic use and mobility decline, this study provides robust evidence that should prompt clinicians to reconsider their prescribing habits, particularly in older populations" (Zinin, 2025).

The implications of this research extend beyond individual patient care. As the population ages, the prevalence of anticholinergic prescriptions is likely to increase, raising public health concerns. According to the World Health Organization, the global aging population is projected to reach 1.5 billion by 2050, thereby necessitating a proactive approach to medication management in older adults (WHO, 2023).

Healthcare professionals are encouraged to minimize anticholinergic exposure whenever possible. Dr. Gray emphasizes the importance of prescribing the lowest effective dose and conducting regular evaluations to identify opportunities for deprescribing these medications. "The goal should be to enhance the quality of life in older adults, not just through pharmacological interventions but by promoting overall health and mobility," she concluded.

This study not only sheds light on the detrimental effects of anticholinergic medications but also serves as a call to action for healthcare providers to adopt more cautious prescribing practices to safeguard the health and mobility of older adults. As further research is conducted, it will be essential to develop clearer guidelines that help mitigate the risks associated with anticholinergic exposure in this vulnerable population.