Anticholinergic and sedative use in older German people: associations with falls and hospitalization

Abstract Background Due to age-related physiological changes that alter drug absorption, distribution, and elimination, polypharmacy and especially anticholinergics and/or sedatives (AS) use in older people may increase adverse outcomes. Prevalence and association of AS use and polypharmacy with falls and hospitalization in people aged 66 to 101 years in Germany are presented. Methods Data from the nationally representative population-based study Gesundheit 65 + (2021-2023, N = 1,474) conducted by the Robert Koch Institute, was analyzed. All medicines used in the 7 days before the interview were documented. With the Anatomical Therapeutic and Chemical classification AS were identified and the number of medications use was calculated. Weighted prevalence and associations with falls and hospitalization, at least once in the last 12 months, were calculated. Results 27.0% of the sample took at least 1 AS. Significant differences were found between sex and age: 27.2% of women and 19.2% of men aged 66-79 took AS compared to 36.6% of women and 28.7% of men aged 80+. Participants using AS reported more often a fall in the last 12 months than those not using AS (38.7% vs. 24.0%; p < 0.01). Hospitalization prevalence differed significantly (p < 0.01) between participants with AS use (total 36.2%; women 33.5%; men 40.8%) compared to those without (total 19.8%; women 17.3%; men 22.7%). Both fall and hospitalization prevalence increased with the total number of medications used (irrespective of AS): among those participants taking 1-4 medications, 18.3% fell and 16.9% were hospitalized; among those taking 5-9 medications, 33.8% fell and 27.1% hospitalized; and among those with 10+ medications, 38.5% and 35.4% respectively. Conclusions Women and people 80+ years old are exposed to a higher prevalence of AS use. AS use and polypharmacy are associated with falls and hospitalization and should be carefully monitored by health professionals. Key messages • Over one quarter of adults 66+ in Germany use anticholinergics and/or sedatives (AS), which is associated with falls and hospitalization. • Rational prescribing and use of AS is recommended.