# Anticholinergic load and quality of life in Australian residential aged care: a retrospective cohort study

## TL;DR

This study found that higher anticholinergic medication load is linked to lower quality of life in aged care residents, especially those without dementia.

## Contribution

The study provides new evidence on the relationship between anticholinergic load and quality of life in aged care, with a focus on dementia status.

## Key findings

- Higher anticholinergic load was associated with lower quality of life scores at follow-up.
- The association was significant in residents without dementia but not in those with dementia.
- Results were consistent across three anticholinergic scales.

## Abstract

The specific impact of anticholinergic load on quality of life is understudied. We aimed to investigate relationships between anticholinergic load and quality of life in residential aged care facilities and differences between residents with and without dementia.

We conducted a retrospective cohort study of 21 residential aged care facilities in New South Wales, Australia. Residents aged ≥65 years for permanent care. Residents had their quality of life measured using the Quality of Life Aged Care Consumers tool in 2023 at baseline (July–September) and follow-up (October–December, the study outcome). Higher scores indicate better quality of life. Anticholinergic load of administered medications between two quality of life measures was evaluated using five existing scales: Anticholinergic Cognitive Burden, Anticholinergic Drug Scale, Anticholinergic Loading Scale, Anticholinergic Risk Scale, and Clinician-rated Anticholinergic Score. Associations between anticholinergic load from each scale and follow-up quality of life scores were examined using linear regression, controlling for age, sex, baseline quality of life scores, and other potential confounders. Interactions between anticholinergic load and dementia were tested. Analyses were conducted for overall cohort and a subgroup analysis was performed for residents with and without dementia.

A total of 927 residents (69.7% female) were included. One-point higher anticholinergic load measured on each of the Anticholinergic Loading Scale, Anticholinergic Risk Scale, and Clinician-rated Anticholinergic Score, was associated with lower quality of life scores at follow-up: −0.24 (95% confidence interval −0.47, −0.01), −0.26 (95% confidence interval −0.46, −0.05), and −0.25 (95% confidence interval −0.49, −0.01), respectively. Associations did not differ by dementia status. In a subgroup analysis, the associations remained statistically significant in residents without dementia (n = 501), but not in those with dementia (n = 426).

Our results indicate that, controlling for baseline quality of life, anticholinergic load was associated with lower quality of life at follow-up over a short period (up to 6 months).