An older adult on multiple medications reports drowsiness and confusion after starting a new medication. What is the next step?

• A. Discontinue all medications
• B. Increase dosage of current meds
• C. Review medications for interactions and anticholinergic burden; adjust or discontinue as appropriate
• D. Start a benzodiazepine

Answer: (C)

When an older adult on multiple meds reports drowsiness and confusion after starting a new medication, the most appropriate next step is to review the entire medication list for interactions and anticholinergic burden, and adjust or discontinue as appropriate. Older adults are especially sensitive to drug interactions and the cumulative anticholinergic effects of many medications, which can cause sedation, delirium, and cognitive changes. By evaluating all drugs for potential interactions with the new one and assessing how each contributes to anticholinergic load, you can identify which meds to modify, substitute, or stop to safely reduce these CNS effects. This approach avoids the risks of stopping all meds abruptly, which could harm the underlying conditions, or increasing doses or starting a benzodiazepine, which would likely worsen sedation and confusion.