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Anticholinergic burden in older women: not seeing the wood for the trees?

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Older people are particularly vulnerable to adverse medicines-related events. Reasons for this include the physiological changes of ageing, the chronic and comorbid conditions they often have, the types of medicines they are commonly prescribed, and the frequency with which they use multiple medicines.1,2 Adverse effects related to medicine use are a significant health problem in this growing population group.3 Many medicines used by older people have anticholinergic effects (effects through one of the body’s principal neurotransmitter systems).4 The anticholinergic effect of an individual medicine may be small, but the anticholinergic effects of multiple medicines may be additive, constituting “anticholinergic burden”.1,4,5

The degree of anticholinergic effect varies greatly between drugs and drug classes.6 Drug classes with anticholinergic effects that are commonly used by older people include gastrointestinal antispasmodics, medicines used for urge incontinence, antipsychotics, and tricyclic antidepressants.4 The anticholinergic effect may be intrinsic to the therapeutic…