Which statement is correct regarding susceptibility to anticholinergic effects?

Which statement is correct regarding susceptibility to anticholinergic effects?

• A. Avoid use in patients with glaucoma
• B. Avoid use in the elderly
• C. Avoid use in children
• D. Avoid use in pregnant women

Answer: (B)

The key idea is that older adults are more vulnerable to anticholinergic effects. As people age, several factors converge: the brain’s acetylcholine reserve and compensatory capacity decline, the blood–brain barrier may become more permeable to drugs, and renal and hepatic clearance often decrease. These changes mean that the same dose of an anticholinergic can produce stronger central effects—such as confusion, delirium, memory problems, agitation, and an increased risk of falls—in the elderly. Because of this heightened sensitivity, clinicians commonly aim to minimize exposure to anticholinergic medications in older patients to reduce these risks. While other considerations matter for safety (anticholinergics can worsen narrow-angle glaucoma due to pupil dilation, and there are cautions around use in children or during pregnancy for different reasons), the specific susceptibility that’s most pronounced and routinely prioritized in practice is the elderly.

The key idea is that older adults are more vulnerable to anticholinergic effects. As people age, several factors converge: the brain’s acetylcholine reserve and compensatory capacity decline, the blood–brain barrier may become more permeable to drugs, and renal and hepatic clearance often decrease. These changes mean that the same dose of an anticholinergic can produce stronger central effects—such as confusion, delirium, memory problems, agitation, and an increased risk of falls—in the elderly. Because of this heightened sensitivity, clinicians commonly aim to minimize exposure to anticholinergic medications in older patients to reduce these risks.

While other considerations matter for safety (anticholinergics can worsen narrow-angle glaucoma due to pupil dilation, and there are cautions around use in children or during pregnancy for different reasons), the specific susceptibility that’s most pronounced and routinely prioritized in practice is the elderly.