Assessing Anticholinergic Effects in Older Adults

Anticholinergic medications are widely used in older adults and are a common source of adverse events in this population. Common drug classes include antiarrhythmics, antidepressants, antiemetics, first generation antihistamines, urinary incontinence antimuscarinic agents, antiparkinsonian agents, antipsychotics, antispasmodics, and skeletal muscle relaxants. These drugs have been associated with delirium, cognitive impairment, sedation, dizziness, falls, fracture, constipation, urinary retention, blurred vision, tachycardia and dry mouth. If possible, these drugs should be avoided in older adults or less toxic agents within the class should be utilized. This chapter will explore the mechanism of action of anticholinergic drugs at both the cellular and organ system level; discuss how to assess for anticholinergic drug burden; list medications with anticholinergic effects as identified in the Beer’s criteria on potentially inappropriate medication use in older adults; review anticholinergic drug–drug interactions; describe contraindications to the use of anticholinergic agents; and explore practical considerations such as the availability of these substances in nonprescription medications, their use at end of life and deprescribing