What is a primary concern with GI antispasmodics that have strong anticholinergic properties in older adults?

• A. They are highly anticholinergic
• B. They have proven efficacy in older adults
• C. They are inexpensive
• D. They cause constipation only

Answer: (A)

The main concept is the danger of strong anticholinergic effects in older adults. GI antispasmodics that block muscarinic receptors can produce widespread anticholinergic effects, and older people are especially sensitive to these. The resulting anticholinergic burden raises the risk of delirium and cognitive impairment, which can lead to confusion, falls, and functional decline. They can also cause dry mouth, constipation, urinary retention, blurred vision, and tachycardia. Because of these safety concerns, the Beers Criteria views highly anticholinergic GI antispasmodics as potentially inappropriate for many older patients. If such therapy is needed, it should be used at the lowest effective dose for the shortest duration, and alternatives with less anticholinergic effect should be considered. The other choices don’t capture the central issue: efficacy in older adults is not the defining concern, cost isn’t the key safety signal, and these drugs don’t affect only constipation.