Drugs with antimuscarinic activity are used for a wide variety of medical conditions. Unfortunately, side effects that develop as a result of muscarinic blockade are common and their frequency and clinical significance appear to increase with advanced age. Nevertheless, such drugs are frequently prescribed to elderly persons, particularly to those living in nursing homes. This review details the prevalence of antimuscarinic drug use in the elderly, the classes of drugs that exhibit antimuscarinic activity, organ-specific effects of muscarinic blockade, side effects identified in elderly individuals, and strategies to prevent or treat complications of antimuscarinic therapy, including recent advances in the development of drugs with selective activity for specific subclasses of muscarinic receptors.