Approximately 1 in 11 adults aged 16 to 59 years (9.2%; approximately 3 million adults) and approximately 1 in 5 adults aged 16 to 24 years (18.6%; approximately 1.1 million adults) reported last year drug use in the year ending June 2022; there was no change compared with the year ending March 2020. Approximately 1 in 11 adults aged 16 to 59 years (9.2%; approximately 3 million adults) and approximately 1 in 5 adults aged 16 to 24 years (18.6%; approximately 1.1 million adults) reported last year drug use in the year ending June 2022. Nishtala PS, McLachlan AJ, Bell JS, Chen TF. Determinants of antipsychotic medication use among older people living in aged care homes in Australia. Int J Geriatr Psychiatry. 2010;25(5):449–57. There is consensus in published literature suggesting a clear association between anticholinergic burden and mobility. Consideration of cognitive anticholinergic effects may be important in interpreting results regarding the association of anticholinergic burden and mobility as anticholinergic drugs may affect mobility through cognitive effects. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.

Cai X, Campbell N, Khan B, Callahan C, Boustani M. Long-term anticholinergic use and the aging brain. Alzheimers Dement. 2013;9(4):377–85. The studies involving human participants were reviewed and approved by Ethik-Kommission der Medizinischen Fakultät der Universität Duisburg-Essen. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements. Author Contributions Nishtala PS, Fois RA, McLachlan AJ, Bell JS, Kelly PJ, Chen TF. Anticholinergic activity of commonly prescribed medications and neuropsychiatric adverse events in older people. J Clin Pharmacol. 2009;49(10):1176–84.This systematic review aimed to synthesise data from published studies regarding the association between anticholinergic burden and mobility. The studies were critically appraised for the strength of their evidence. Methods

Alcohol and drug misuse and treatment in adults from Public Health England's (PHE’s) national drug treatment monitoring system (NDTMS). Anticholinergic effects on peripheral function include dry mouth, blurred vision, constipation, urinary retention, and an elevated heart rate. Central effects may lead to sedation, confusion, dizziness, and, in some cases, cognitive impairment. The likelihood of experiencing these side effects increases when multiple medications with anticholinergic properties are used concurrently. Anticholinergic Cognitive Burden Scale (ACB) developed by Boustani et al. [ 24] is based on a systematic literature review of medicines with known anticholinergic activity. The ACB scale included medicines that were likely to have a negative impact on cognition [ 27, 28]. A multi-disciplinary panel assessed individual drugs to have none, possible, or definite anticholinergic properties with a score ranging from 0 to 3. ACB scale reported 88 medicines with known anticholinergic activity. Studies that employed the ACB scale have shown that higher anticholinergic burden predicts cognitive impairment in older people. In addition, the study conducted by Pasina L et al. showed that anticholinergic burden quantified by the ACB scale predicted impairment in physical functioning [ 27]. Kersten H, Molden E, Tolo IK, Skovlund E, Engedal K, Wyller TB. Cognitive effects of reducing anticholinergic drug burden in a frail elderly population: a randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2013;68(3):271–8. Mintzer J, Burns A. Anticholinergic side-effects of drugs in elderly people. J R Soc Med. 2000;93(9):457–62.

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The primary electronic literature search identified a total of 1250 articles from 3 different databases such as Ovid MEDLINE, EMBASE, and PsycINFO. EndNote was used to eliminate duplicates and we considered 932 articles for screening. Out of 932 screened articles based on title and abstract, only 21 were eligible for full-text analysis. From the eligible 21 studies, 14 were excluded on full text analysis according to the set inclusion and exclusion criteria. Hence, in total, 7 studies were included in this review that considered expert opinion/s in the development of the anticholinergic rating scales [ 9, 19, 22- 26]. Figure 1 depicts a flow-diagram of the identification, screening, eligibility and exclusion process. Carnahan RM, Lund BC, Perry PJ, ET AL. (2006) The Anticholinergic Drug Scale as a measure of drug-related anticholinergic burden: associations with serum anticholinergic activity . J Clin Pharmacol. doi: 10.1177/0091270006292126. Huang K-H, Chan Y-F, Shih H-C, Lee C-Y. Relationship between Potentially Inappropriate Anticholinergic Drugs (PIADs) and Adverse Outcomes among Elderly Patients in Taiwan. J Food Drug Anal. 2012;20(4):930–7.

The Crime Survey for England and Wales (CSEW) is recognised as a good measure of drug use for the drug types and population it covers. However, it does not provide as good coverage of problematic drug use, as such users may not be a part of the household resident population that is covered by the survey. Drug misuse data included in this release are sourced from the Crime Survey for England and Wales (CSEW). Our User guide to crime statistics for England and Wales provides detailed information about the crime survey. UB: conception and design. MSp: analysis of the data. UB and MSp: collection and interpretation of data. UB: drafting the article. All authors: revising it critically for important intellectual content. Conflict of Interest

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A systematic review was conducted to assess the effectiveness of anticholinergic burden scales in predicting adverse outcomes in older individuals. This is particularly relevant as the anticholinergic burden has been associated with negative outcomes in aging populations.

With increasing age comes age-related comorbidities that may be influenced by lifestyle, genomic makeup and other demographic factors. The increasing number of health issues require multiple medications (polypharmacy) to treat them. A 2005 study found that as of 2002, older adults defined as ≥ 65 years comprised 12% of the population of the United States but constituted 33% of its prescription drug expenditure (50 billion dollars) [ 1]. Whilst polypharmacy may be beneficial in treating underlying health conditions in older adults, it increases the risk of adverse drug events. In particular, taking multiple drugs with anticholinergic effects increases the risk of anticholinergic burden (AB) in older adults because of age-related pharmacokinetic and pharmacodynamic changes [ 2]. Drug use may not be independently related to lifestyle factors but instead affected by factors such as age, as younger people may be more likely to visit nightclubs or bars. Household and area characteristics Ecstasy: Prevalence of last year ecstasy use was at its lowest level since data were first collected; 0.7% of adults aged 16 to 59 years and 1.1% of adults aged 16 to 24 years had reporting taking this drug in the last year; a 47% decrease for those aged 16 to 59 years and a 72% decrease for those aged 16 to 24 years compared with the year ending March 2020.

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We cordially thank Jennifer Haverkemper, MSc (Psychology), for her assistance in developing the questionnaire for Cohort 1, and Ann-Christin Kanti, MD, for data entry and maintenance. We also thank Gabriele Lührmann, chief secretary of the Department for Psychiatry, Psychotherapy, and Psychosomatics at the EVK Castrop-Rauxel for organizing correspondence with colleagues. We also thank the many physicians who kindly took the time to participate in this project. Supplementary Material Koyama A, Steinman M, Ensrud K, Hillier TA, Yaffe K. Ten-year trajectory of potentially inappropriate medications in very old women: importance of cognitive status. J Am Geriatr Soc. 2013;61(2):258–63.