Many common medicines in older adults have anticholinergic effects: bladder antimuscarinics, tricyclic antidepressants, some antihistamines and antipsychotics among them. Their combined burden causes dry mouth, constipation, urinary retention and, importantly, confusion and falls.
Dry mouth is often the first visible sign. It is a useful prompt to tally the anticholinergic load and to deprescribe where possible before adding another drug to treat the symptom.
- List every medicine with anticholinergic effects when an older patient reports a dry mouth.
- Use an anticholinergic burden scale to quantify the total load.
- Deprescribe or substitute where possible, starting with the least essential.
- Watch for linked effects: confusion, constipation, retention and falls.
Why it matters
The same drugs that dry the mouth also cloud thinking and cause falls.
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