Anticholinergic Medications After 65: Memory, Falls and What to Review

For Patients & FamiliesAnticholinergic Drugs After 65: Memory
Written By Sonia Mia Diaz, MD

Anticholinergic medications, found in some sleep aids, allergy pills, bladder medicines, older antidepressants and muscle relaxants, can cause confusion, unsteadiness, constipation and blurred vision after 65, and heavy long-term use has been linked to a higher risk of dementia. The American Geriatrics Society recommends that older adults avoid many of them. A medication review can often find a safer plan. Changes should be made with the prescriber, not by stopping a medication on your own.

What "Anticholinergic" Means

Acetylcholine is one of the body's main chemical messengers. In the brain it supports memory and attention. Elsewhere it helps the bladder empty, keeps the bowels moving, keeps the mouth moist and lets the eyes focus. Anticholinergic medications block it. Sometimes that is the point, as with bladder medicines that calm an overactive bladder, but for most medications on the list below it is an unwanted side effect.

After 65, the brain becomes more sensitive to that blocking effect, and the kidneys and liver clear many medications more slowly, so levels build up. The effects also stack: a sleep aid, an allergy pill and a bladder medicine that each seem mild on their own can add up to noticeable confusion. Doctors call this combined effect the anticholinergic burden.

Common Medications to Know

These are common examples, not a complete list. Many people don't know their medication belongs on it.

  • Over-the-counter sleep aids and "PM" products: diphenhydramine (Benadryl, and the "PM" in many pain relievers) and doxylamine (Unisom and some nighttime cold medicines)

  • Older allergy and nausea medicines: chlorpheniramine, hydroxyzine, meclizine and promethazine

  • Bladder medicines: oxybutynin, tolterodine, solifenacin and others in this group

  • Older antidepressants: amitriptyline, nortriptyline, imipramine and higher doses of doxepin, plus the newer antidepressant paroxetine

  • Muscle relaxants: cyclobenzaprine and similar medicines

  • Some medicines for Parkinson disease, psychosis and seizures

The 2023 Beers Criteria, the American Geriatrics Society's guide to medications that carry extra risk after 65, recommends avoiding strongly anticholinergic medications in most older adults and avoiding taking 2 or more of them together.

Short-Term Effects: Confusion, Falls and More

The effects most people notice come on within days or weeks:

  • Forgetfulness, slowed thinking or a "foggy" feeling

  • Confusion, especially at night or during an illness. In some people this becomes delirium, a sudden state of confusion that needs prompt medical attention.

  • Dizziness, blurred vision and unsteadiness

  • Dry mouth, constipation and trouble emptying the bladder

  • A faster heartbeat

Older adults who take medications with a moderate to high anticholinergic burden fall more often in studies, though most of these studies have limits. Dizziness, blurred vision, nighttime trips to the bathroom and slowed thinking all make a fall more likely.

What the Research Says About Dementia

Several large studies have found that people who took strongly anticholinergic medications for years were more likely to develop dementia later. In a Seattle study of adults 65 and older, those with the most use, roughly the equivalent of a daily dose for more than 3 years, had about a 54% higher risk. A large study in England found a similar pattern, strongest for anticholinergic antidepressants, bladder medicines, and some medicines for psychosis, Parkinson disease and seizures. In both, risk rose with more use.

These studies show a link, not proof that the medications cause dementia. People who need these medications may differ in other ways, and early dementia can itself lead to new prescriptions. Reviews that pool the research rate the evidence as low certainty. Small trials of stopping anticholinergic medications have not yet shown better memory, partly because the trials were short and many people stayed on their medications.

What this means for you: there is no reason to panic over past use, and the short-term effects are reason enough to review these medications now.

How to Review a Medication List

Gather every medication in one place, including over-the-counter sleep aids, allergy pills, cold medicines and supplements, and bring them to the next visit. Then ask:

  • What is each medication for, and is it still needed?

  • Does any of them have anticholinergic effects? Are two of them doing the same job?

  • Is there an option with less of this effect, or a non-medication approach, for sleep, bladder symptoms or pain?

  • If we make a change, what is the plan, and what should I watch for?

Don't stop a prescription medication suddenly. Some, including paroxetine and the older antidepressants, can cause discontinuation symptoms such as dizziness, nausea, poor sleep and irritability when stopped quickly. The symptoms a medication was treating can also come back. Changes usually work best one at a time, slowly, with follow-up.

What Medicare Covers

Medicare's yearly wellness visit includes a review of your current prescriptions and a check for memory problems. You pay nothing for it when your provider accepts assignment, though other tests or services done the same day may have a cost.

If you have a Part D drug plan, you may also qualify for a free comprehensive medication review with a pharmacist through the plan's Medication Therapy Management program. Eligibility depends on having several chronic conditions, taking several Part D medications and having high expected drug costs ($1,276 or more in 2026). Your plan will tell you if you qualify, or you can call and ask.

Original Medicare Part B also covers outpatient psychiatric care, including visits by video. After the Part B deductible ($283 in 2026), you generally pay 20% of the Medicare-approved amount. For help comparing plans, Virginia residents can contact VICAP and Florida residents can contact SHINE.

How Welmivia Can Help

Welmivia is a participating Medicare practice. Dr. Diaz sees adults with Original Medicare located in Virginia or Florida by video. A visit can review every medication that affects mood, sleep, memory and balance, including the psychiatric ones. When a medication should be reduced, Dr. Diaz uses slow, proportional tapers based on the Maudsley Deprescribing Guidelines and coordinates with the primary care physician. We are not able to see patients with Medicare Advantage or Medicaid. Private-pay patients are welcome too.

To check coverage or ask about a first visit, call 434-623-0003 or use our Medicare request form. Related reading: Sleeping Pills After 60: What to Ask Before the Next Refill.

What to Take Away

  • Many common medications, including over-the-counter "PM" sleep aids, have anticholinergic effects that can cause confusion and falls after 65.

  • Long-term heavy use is linked to dementia risk, but the link is not proven to be cause and effect.

  • Bring every medication to a review, and make any change slowly with the prescriber.

Welmivia is not a crisis service. If someone is in danger, call 911. For a mental health crisis, call or text 988.

Sources

This guide is general information, not medical advice for your situation. Do not change any medication without talking with your prescriber.

Sonia Mia Diaz, MD

Sonia Mia Diaz, MD, is the founder and medical director of Welmivia, a physician-led psychiatric practice that cares for adults in Virginia and Florida by video, including patients with Original Medicare. Her work focuses on diagnostic clarity, careful medication management, and coordinated care with primary care physicians.

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