Medication groups that deserve particular attention in older adults
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Strong anticholinergic antidepressants — such as amitriptyline and paroxetine.
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First-generation antihistamines — such as diphenhydramine and chlorpheniramine.
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Bladder antimuscarinics — such as oxybutynin.
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Anticholinergic antiparkinsonian drugs — some can substantially increase cognitive side effects.
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Certain antipsychotics with anticholinergic properties — their use in older adults requires careful consideration.
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Some antiepileptic medicines with anticholinergic activity — cognitive effects can be important in susceptible patients.
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Benzodiazepines — such as diazepam, lorazepam, and clonazepam. These are strongly associated with short-term cognitive impairment, delirium and falls in older adults; the evidence for causing dementia itself is less definitive than it is for anticholinergic exposure.
The American Geriatrics Society’s 2023 Beers Criteria identifies numerous medications that may be inappropriate or require caution in adults 65 and older because of their potential risks.
