OBJECTIVES: Anticholinergic medications are frequently prescribed in the elderly, and have been associated with potential central and peripheral adverse events. The current study examined the risk of all-cause hospitalization associated with anticholinergic use in the elderly. METHODS: The study used a case-control design nested within a cohort of elderly individuals enrolled in a regional Medicare Advantage Prescription Drug Plan. The base population consisted of individuals aged >65 years, who survived during the entire study period, had at least one institutional and one outpatient claim in first 6 months (January-June 2009) and no event of hospitalization during the first 6 months (Base Period). Cases for the study experienced incident inpatient hospitalization anytime following the base period.  For each case, 4 age- and sex-matched controls were selected using incidence density sampling (incidence density 1:4). The primary outcome measure was all-cause inpatient hospitalization. Prescription of any anticholinergic medication 30 days before the hospitalization date formed the primary exposure, and was defined using the Anticholinergic Drug Scale (ADS). Conditional logistic regression stratified on matched case-control sets was used to model the hospitalization risk, after controlling for additional risk factors predictive of the outcome. RESULTS: There were 295 cases that experienced incident hospitalization, and 1,180 age and sex-matched controls. After controlling for other covariates, use of anticholinergic medications was not associated with a significantly higher risk of hospitalization (Relative Risk, RR 0.85; 95% CI, 0.62-1.17) compared to no use. The findings remained unchanged after considering higher level (Level 2/3) anticholinergic use (RR 0.97; 0.61-1.54). CONCLUSIONS: The study found that anticholinergic medication use was not associated with a significantly higher risk of hospitalization compared to no use, among the elderly with no history of hospitalization. Future studies with diverse samples are required to address the role of dose and concomitant use of anticholinergic agents in the elderly.