Overactive bladder is a common condition with increased prevalence among the elderly population. Anti-cholinergics have been the mainstay of pharmacologic therapy for many years with beta-3 agonists introduced more recently. Over the past decade anti-cholinergics have been associated with cognitive decline, falls and fractures, and increased mortality. Certain formulations seem to incur higher risk than others owing to various pharmacologic properties. Beta-3 agonists have not been associated with these adverse events. This article serves as a review of the literature exploring the risks of various overactive bladder therapies.