What is a key safety consideration when using antimuscarinic therapy in older adults?

• A. It improves cognition.
• B. Anticholinergic burden leading to cognitive impairment, delirium, and falls risk.
• C. It reduces urinary retention risk.
• D. It causes significant hair loss.

Answer: (B)

Antimuscarinic therapy in older adults carries a key safety concern: the anticholinergic burden from these drugs can impair cognition, precipitate delirium, and raise the risk of falls. Acetylcholine supports attention and memory, and blocking its receptors reduces brain cholinergic signaling. In older individuals, this disruption is more likely to produce cognitive slowing, confusion, or delirium, and the resulting impairment in attention and balance increases the chance of falls. The overall risk grows with multiple anticholinergic medications, so clinicians aim to minimize total burden by choosing lower-risk agents, using the smallest effective dose, and regularly reviewing the medication list. This safety issue is not about improving cognition, reducing urinary retention, or hair loss—those do not capture the central risk concern in this context.