Why is combining two anticholinergic medications discouraged in older adults?

• A. It increases the risk of cognitive decline, delirium, and falls or fractures.
• B. It improves cognitive function.
• C. It has no impact on cognition.
• D. It reduces the risk of delirium.

Answer: (A)

The concept being tested is how anticholinergic burden affects older adults. Anticholinergic medications block acetylcholine receptors, and older people are more vulnerable to their effects because of decreased drug clearance and increased brain sensitivity. When two anticholinergic drugs are used together, their effects add up, creating a higher overall burden. This raises the risk of cognitive decline, delirium, and falls or fractures—outcomes that are particularly dangerous in the elderly.

So the best answer is that combining two anticholinergic medications increases these risks. The idea that it would improve cognition, have no impact, or reduce delirium contradicts what we know about anticholinergic burden in aging.