What question did this study set out to answer?

This analysis aims to explore changes in anticholinergic burden and its relationship with mortality among older adults in the US over 32 years.

March 7, 2026

Thirty-two-year trends in anticholinergic burden and associated mortality among US older adults: a population-based study

Key Result

High anticholinergic burden (score ≥3) independently increased all-cause mortality by 54-65%, cardiovascular mortality by 66-94%, and cancer mortality by 31-40% in US older adults.

Key Points

This analysis aims to explore changes in anticholinergic burden and its relationship with mortality among older adults in the US over 32 years.
Analyzed data from 16,188 older adults participating in the NHANES.
Assessed anticholinergic burden using Beers criteria and four validated scales.
Examined prevalence trends with survey-weighted logistic regression.
Linked mortality data to the National Death Index and employed Cox proportional hazards models for analysis.
Significant decline in the prevalence of strong anticholinergic medication use and high burden from 1988 to 2020.
High anticholinergic burden was associated with a 65% increased risk of all-cause mortality.
High burden also correlated with a 94% increase in cardiovascular mortality and a 40% increase in cancer mortality.

Structured PICO

Does high anticholinergic burden increase the risk of all-cause, cardiovascular, and cancer mortality in older adults?

Population

16,188 older adults in the US from the National Health and Nutrition Examination Survey (NHANES) spanning 32 years (1988-1994 to 2017-March 2020).

Intervention

High anticholinergic burden (score ≥ 3) assessed using 2023 American Geriatrics Society Beers Criteria and four validated scales (ARS, ADS, ACB and ACSBC)

Outcome

All-cause mortality, cardiovascular mortality, and cancer mortality ascertained through linkage to the National Death Indexhard clinical

High anticholinergic burden is a strong, independent predictor of all-cause, cardiovascular, and cancer mortality among US older adults, highlighting the need for deprescribing initiatives.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Background Anticholinergic burden (AB) is linked to adverse health outcomes and mortality among older adults. Yet, the national trends in AB and its long-term mortality risk are not well-defined. Methods We analysed data from 16 188 older adults in the National Health and Nutrition Examination Survey (NHANES) spanning 32 years. AB was assessed using the 2023 American Geriatrics Society Beers Criteria® and four validated scales (ARS, ADS, ACB and ACSBC). Age-standardised prevalence trends were examined using survey-weighted logistic regression. Mortality outcomes were ascertained through linkage to the National Death Index and analysed with Cox proportional hazards models to estimate adjusted hazard ratios (HRs). Results From 1988–94 to 2017–March 2020, the prevalence of any strong anticholinergic medication use and high AB (score ≥ 3) declined significantly across all scales (all PTrend .05). During a median follow-up of 81 months, 9006 deaths (49.3%) occurred. After comprehensive adjustment for covariates, high AB was independently associated with elevated all-cause mortality (ADS: HRs 1.65, 95% CI 1.51–1.81; ACB: HRs 1.54, 95% CI 1.41–1.68), cardiovascular mortality (ADS: HRs 1.94, 95% CI 1.71–2.20; ACB: HRs 1.66, 95% CI 1.46–1.88) and cancer mortality (ADS: HRs 1.40, 95% CI 1.18–1.68; ACB: HRs 1.31, 95% CI 1.09–1.57). Conclusions While the prevalence of AB among US older adults has declined over the past three decades, high exposure remains a strong, independent predictor of all-cause, cardiovascular and cancer mortality. These findings highlight the ongoing need for safer prescribing and sustained deprescribing initiatives in geriatric care.

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