What is a major safety concern with antimuscarinic therapy in older adults?

• A. Hypertension.
• B. Anticholinergic burden leading to cognitive impairment, delirium, and falls risk.
• C. Dehydration.
• D. Nausea.

Answer: (B)

Antimuscarinic therapy in older adults carries a high anticholinergic burden, which is the major safety concern. Blocking muscarinic receptors, including those in the brain, reduces cholinergic signaling that supports attention, memory, and cognition. In the elderly, this can lead to cognitive impairment and delirium, especially with accumulated exposure from multiple medications. Delirium and cognitive disruption increase the risk of falls and functional decline, making this the most clinically significant safety issue. Hypertension, dehydration, and nausea can occur, but they are not as closely tied to the central risks of anticholinergic therapy in older adults as cognitive impairment, delirium, and falls.