An 82-year-old woman with a history of generalized anxiety disorder, overactive bladder, and seasonal allergies is referred to the PMHNP after a second fall in three months. Her current medications include paroxetine 20 mg daily, oxybutynin 5 mg twice daily, and diphenhydramine 25 mg nightly. She reports worsening confusion over the past several months and difficulty with short-term memory. Her daughter states that these cognitive changes seem to fluctuate throughout the day. The PMHNP applies the AGS Beers Criteria to evaluate the medication regimen. Which of the following best describes the anticholinergic burden concern in this patient?