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To determine which older adults tend to receive potentially inappropriate medications (PIMs), how this may differ according to cognitive status, and how the trajectories of PIM use change over time.

Ten‐year longitudinal cohort study.

Three clinical sites in the United States.

One thousand four hundred eighty‐four community‐dwelling women aged 75 and older.

At follow‐up, cognitive status was ascertained and classified as normal, mild cognitive impairment (MCI), or dementia. Beers 2003 criteria and other literature were used to identify PIMs from detailed medication inventory performed at three time points. Anticholinergic load was measured using the Anticholinergic Cognitive Burden Scale (ACB), which assigns medications a value from 0 to 3 depending on anticholinergic properties.

At baseline, 23.9% of women were taking at least one PIM …