In older adults, several drugs with modest anticholinergic effects — some antihistamines, bladder antimuscarinics, tricyclics and certain antipsychotics — add up. Cumulative burden is linked with confusion, falls, constipation and urinary retention.
A quick tally using a recognised anticholinergic burden scale at medication review identifies the drugs most worth reducing first.
- Score anticholinergic burden at every medication review in older adults
- Prioritise stopping or switching drugs with strong anticholinergic effects
- Check over-the-counter sleep aids and cold remedies, which often contain them
- Review bladder antimuscarinics in anyone with cognitive decline
Why it matters
Anticholinergic load causes harm that is easily mistaken for ageing or dementia.
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