[From loss of autonomy to dysautonomia: anticholinergic drugs in geriatrics]

Elderly patients represent a huge market for the pharmaceutical industry because population is aging and multimorbidity is concentrated on the last years of life. The risk of inappropriate prescribing is high in this age group. Among the potentially toxic drugs, antimuscarinics occupy a prominent place. It should be necessary as far as possible to avoid them, especially if treatments are illogical. In the case of incontinence due to prostatic disease anticholinergic drugs usually worsen the problem. In patients with dementia, they have an opposite effect to inhibitors of acetylcholinesterase. Where no alternatives exist, it is recommended to make short term treatments and to reassess periodically the indication.