Introduction
Observational studies have indicated association between recent elevated anticholinergic burden and increased risk of falls and fractures. However, this observed association may not necessarily be due to the anticholinergic burden itself but could be substantially confounded by indication.
Objective
To evaluate the association between a recent increase in anticholinergic burden and risk of falls and fractures in Taiwanese population.
Methods
We conducted a case-case-time-control study using National Health Insurance Research Database in Taiwan. We included patients over 65 who were hospitalized or admitted to emergency room due to falls and fractures from 2016 to 2020, with index date as admission date. Future cases were those occurred within 60-150 days after matched index date. We defined hazard period as 60 days before index date, with reference period randomly selected from 121 to 300 days before index date. We classified sum of Anticholinergic Cognitive Burden Scale (ACB) within each period into three groups: 0, 1-2, 3+ points. We used conditional logistic regression model to estimate effect of anticholinergic burden on risk of falls and fractures.
Results
We included 434,322 patients, with a mean age of 77 and 36% male. The crude case-crossover analysis showed that an ACB score of 1-2 points (OR 1.27, 95% CI 1.25-1.30) and 3+ points (OR 1.42, 95% CI 1.40-1.44) were associated with a higher risk of falls and fractures. The case-case-time-control analysis suggested that an ACB score of 1-2 points (OR 1.29, 95% CI 1.24-1.33) and 3+ points (OR 1.40 95%, CI 1.37-1.44) were also associated with an increased risk of falls and fractures.
Conclusion
Our findings suggest an association between recently elevated anticholinergic burden and an increased risk of falls and fractures. We recommend that clinicians monitor drugs with anticholinergic properties to prevent acute risk of falls and fractures.

Keywords: anticholinergic burden, fall and fracture

Introduction There is limited evidence on the association between recently elevated anticholinergic burden and the risk of urinary retention.

Aims To evaluate the association between recently elevated anticholinergic burden and the risk of urinary retention among older adults in Taiwan.

Methods We conducted a case-case-time-control study using data from the Taiwan National Health Insurance Research Database (NHIRD). Inclusion was older adults (65+) diagnosed with urinary retention between 2017 and 2021. We selected future cases, defined as those with urinary retention occurring within 60-150 days after the matched event date. The hazard period was defined as the 60 days preceding the diagnosis, while the referent periods were random 60-day intervals within the 121 to 300 days before the diagnosis. We used the Anticholinergic Cognitive Burden Scale (ACB) to categorize scores into three groups: 3+, 1-2, and 0. Conditional logistic regression was applied to assess the odds ratios (ORs) and 95% confidence intervals (95% CIs).

Results Of 135,116 future cases were eligible for the case-case-time-control analysis. The average age was 78.3 years, and 73.3% were male. The crude case crossover analysis showed that an ACB score of 1-2 points (OR 1.80; 95% CI, 1.74-1.87) and 3+ points (OR 2.31; 95% CI, 2.25-2.37) were associated with a higher risk of urinary retention. The case-case-time-control analysis revealed that an ACB score of 1-2 points had an OR of 1.68 (95% CI, 1.57-1.80) and an ACB score of 3+ points had an OR of 2.12 (95% CI, 2.03-2.22), suggesting that recently elevated anticholinergic burden is associated with an increased risk of urinary retention.

Discussion/Conclusion Older adults with recently elevated anticholinergic burden were associated with an increased risk of urinary retention. This underscores the importance of monitoring the risk of urinary retention in individuals recently receiving anticholinergic drugs.

Keywords: anticholinergic burden, urinary retention, older adults

Introduction: Polypharmacy may lead to adverse health outcomes in older adults, but the relationship between polypharmacy and biological aging remains poorly defined. This study aims to investigate the association between polypharmacy and accelerated biological aging, as well as the mediating effect of inflammatory markers.
Methods: Participants who were 65 years of age or older and took at least one prescription medication from the National Health and Nutrition Examination Survey (1999-2018) were included in the cross-sectional study. The concurrent use of 5 to 9 medications was defined as polypharmacy, while the use of more than 9 medications was defined as hyper-polypharmacy. Biological aging was assessed from multiple perspectives, including phenotypic age, biological age, AnthropoAge, frailty index, telomere length and circulating α-klotho concentration. The degree of inflammation was quantified using four indices constructed based on blood cell counts, including the systemic immune-inflammation index, systemic inflammatory response index, neutrophil-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio. Weighted multiple linear regression analysis were performed to examine the association between polypharmacy and accelerated biological aging. Mediation analysis was conducted to assess the influence of inflammatory markers on the relationship between polypharmacy and accelerated biological aging.
Results: A total of 12,238 participants were included, of whom 4,679 (weighted percentage: 38.0%) were taking between 5 and 9 medications, while 538 (weighted percentage: 4.5%) were taking more than 9 medications. After adjustment for multiple covariates, both polypharmacy and hyper-pharmacology remained significantly associated with α-klotho, phenotypic age, biological age, AnthropoAge, and frailty index, but not telomere length. Mediation analysis revealed that the association between polypharmacy and accelerated biological aging was partially mediated by inflammatory markers, with the proportion of mediation varying from 0.69% to 19.60% (all p <.05).
Conclusion: These findings suggest that polypharmacy is significantly associated with multiple biological aging measures, which may be partially mediated by inflammation.

Introduction: Hip fractures are common among the elderly and are associated with high mortality rates. Accurate prediction of long-term prognosis at the time of fracture using preoperative data is crucial for planning appropriate medical interventions and resource allocation, thereby improving clinical management and patient outcomes.
Aims: This study aimed to create and validate the Shizuoka Hip Fracture Prognostic Score (SHiPS), a model designed to predict long-term mortality in elderly patients with hip fractures using accessible preoperative information.
Methods: We conducted a retrospective cohort study using the Shizuoka Kokuho Database, a Japanese claims database spanning 8.5 years, which included 43,529 patients aged 65 years and older who experienced their first hip fracture between April 2012 and September 2020. Prognostic factors were identified through univariate and multivariate Cox regression analyses. Based on the hazard ratios, we developed the Shizuoka Hip Fracture Prognostic Score (SHiPS), categorizing mortality risk into four levels. The score was validated using receiver operating characteristic (ROC) curve analysis for 1-year, 3-year, and 5-year mortality.
Results: The key prognostic factors identified included age, sex, fracture site, nursing care certification, and several comorbidities such as any malignancy, renal disease, congestive heart failure, chronic pulmonary disease, liver disease, metastatic solid tumor, and deficiency anemia. The SHiPS, with a score range of 0 to 64, demonstrated reliable predictive performance with area under the receiver operating characteristic (ROC) curves of 0.718 for 1-year, 0.736 for 3-year, and 0.758 for 5-year mortality. Notably, the predictive accuracy remained above 0.7 (AUC) for patients regardless of whether they underwent surgery, highlighting its robustness across different treatment scenarios.
Conclusion: The Shizuoka Hip Fracture Prognostic Score (SHiPS) effectively predicts long-term mortality in elderly hip fracture patients using preoperative data. This tool can be instrumental in clinical decision-making and improving patient outcomes by enabling early risk assessment.

Introduction:
Sedative and anticholinergic medications are linked to poorer outcomes, such as worsening cognitive function, in older people, especially those with dementia. However, national population-level estimates of their use and the associated sociodemographic factors are lacking in Australia.

Aims:
To estimate the prevalence and risk factors for sedative and anticholinergic medication use in older Australians with dementia.

Methods:
This study used linked 2021 Census and Pharmaceutical Benefits Scheme (PBS) data, including people aged 65 or above. Dementia was defined as a self/proxy-reported diagnosis in 2021 and/or at least one dispensing of an antidementia drug between 2016 and 2021. Main outcomes were sedative and anticholinergic medication use, defined using the Drug-Burden Index (DBI) (at least one DBI contributing drug) and the Anticholinergic Cognitive Burden Scale (ACB) (ACB score ≥3). Prevalence was calculated by 5-year age strata. Binary logistic regression models explored associations with self-reported comorbidities and sociodemographic factors.

Results:
Of the 177,809 people with dementia, over half used at least one DBI contributing drug. Highest use was in those aged 65-69, with two-thirds using at least one DBI contributing drug. Anticholinergic burden was also highest in this age group (19%). Prevalence of DBI drug use and anticholinergic burden declined with increasing age. Those living in non-private dwellings and requiring assistance with core activities were at increased risk, while older age, higher socioeconomic status, and higher education were associated with lower risk. Antidementia medication use was associated with a lower risk of high anticholinergic burden.

Discussion:
Over half of people with dementia were exposed to sedative and anticholinergic medications, with risk higher in certain sociodemographic groups. Regular review and ongoing monitoring are necessary to ensure appropriate use of these drugs in this vulnerable population.

Introduction
Despite their frequent concurrent use, little is known about the safety of concomitant use of calcium channel blockers (CCBs) and selective serotonin reuptake inhibitors (SSRIs) with regard to fracture risk.

Aims
We compared risk of fractures in patients concomitantly treated with CCBs and SSRIs versus CCB-only users. Additionally, we compared the risk of fractures among concomitant CCB-SSRI users initiating cytochrome P450 3A4 (CYP3A4) inhibiting SSRIs (e.g., fluoxetin) versus non-CYP3A4 inhibiting SSRIs (e.g., citalopram).

Methods
This retrospective cohort study used IBM MarketScan® commercial claims and Medicare Supplemental database (2007-2019). We included adults diagnosed with hypertension and depression, newly initiating SSRIs while being treated with CCBs (i.e., concomitant CCB-SSRI users) and those who did not (i.e., CCB only users). Our primary outcome was the first occurrence of any fracture. We used stabilized inverse probability of treatment weighting (sIPTW) to balance baseline risk between groups. Cox proportional hazard regression modeling was used to compare fracture risk.

Results
We identified 191,352 concomitant CCB-SSRI and 956,760 CCB-only users (mean age 56 years, 50.1% males). After sIPTW, compared to CCB only users, CCBs-SSRIs users had a higher risk of fractures (hazard ratio (HR):1.43, [95% confidence interval (CI):1.22-1.66]). No difference in the risk of fractures between concomitant users of CCB-CYP3A4 inhibiting SSRIs and those of CCB-non CYP3A4 inhibiting SSRIs (HR:1.10, [95%CI:0.87-1.40]) was observed.

Discussion/Conclusions
Short term concomitant CCB-SSRI use was associated with increased fracture risk. However, concomitant CCBs and CYP3A4 inhibiting SSRIs compared to CCBs and non CYP3A4 inhibiting SSRIs use was not associated with increased risk.