Association between anticholinergic burden scales and recurrent falls in independently living older adults: a cross-sectional study

: This study examined the association between medications with anticholinergic (ACh) activity and the risk of falls in community-dwelling older adults enrolled in a home monitoring service. A cross-sectional design was applied, and logistic regression analyses were adjusted for age, sex, comorbidities, and functional status. The sample included 84 participants who had experienced at least one fall, of whom 72.6% were single fallers and 27.4% recurrent fallers (≥2 falls in 12-months of observation). Participants were divided into two groups: those taking medications (n = 55) and those not on medication (n = 29). A total of 126 falls were reported, with no significant difference in the number of falls between the two groups. The prevalence of ACh burden, assessed using ten different scales, ranged from 5.4% to 30.9% among fallers. Within the medication group, no significant differences were observed in the presence of ACh burden (≥1) between single and recurrent fallers. However, recurrent fallers in this group (n = 15) had higher scores on some scales compared with single fallers. Despite this, the discriminative ability of the ACh burden scales for identifying recurrent fallers were limited, with several, particularly the ALS and CrAS scales, failing to reach acceptable thresholds. After adjustment, the AAS scale suggested that older adults were over nine times more likely to experience recurrent falls compared with a single fall (OR=9.24; 95% CI 1.02-77.49; p = 0.004). Overall, these findings highlight the limited clinical utility of current ACh burden scales in supporting medication review as part of fall prevention strategies for older adults.