In which population is the use of anticholinergic agents particularly concerning, and why?

The use of anticholinergic agents is particularly concerning in the elderly population due to the heightened risk of cognitive impairment and falls associated with these medications. Anticholinergics work by blocking the action of acetylcholine, a neurotransmitter involved in many functions in the brain and body, including memory and cognitive function. In older adults, who may already be experiencing age-related cognitive decline, these drugs can further exacerbate issues such as confusion, memory loss, and delirium.

Additionally, anticholinergic effects can lead to decreased coordination and balance, thereby increasing the risk of falls—one of the most serious concerns for elderly patients, as falls can result in significant morbidity and mortality. Studies have confirmed that certain anticholinergic agents are associated with a higher incidence of adverse cognitive outcomes in elderly individuals, reinforcing the importance of cautious prescribing and monitoring in this vulnerable population.