In older adults, which medication type is listed as inappropriate due to delirium risk?

• A. Anticholinergics
• B. Antipsychotics
• C. Benzodiazepines
• D. Corticosteroids

Answer: (A)

Anticholinergic medications are particularly risky for delirium in older adults because they block acetylcholine in the brain, a neurotransmitter crucial for attention and cognition. Aging reduces the brain’s reserve and makes seniors more sensitive to these effects, so even typical doses can trigger acute confusion and delirium. This central anticholinergic burden is a well-recognized reason Beers Criteria flags many of these drugs as inappropriate in older patients.

While other drug classes can contribute to delirium (for example, benzodiazepines, certain antipsychotics, and corticosteroids may also worsen confusion), anticholinergics are singled out because their mechanism directly disrupts cholinergic signaling and accumulates with age, making delirium more likely across various drugs in that category.