If you’re helping an older person with health and healthcare, chances are that person is taking at least a few prescription medications, if not several.
Do you ever wonder if he or she is on the right medications? Do you worry about side-effects and interactions?
These are sensible concerns to have. Many older adults end up experiencing “polypharmacy,” which means taking more than 5 medications concurrently.
And although medications do often help maintain health and wellbeing, studies have repeatedly shown that lots of older adults end up suffering from problems related to medication.
Polypharmacy, predictably, increases the risk of problems. But even older adults taking 1-3 medications can encounter problems.
So I want to share a list of common ways that medications affect the health and wellbeing of aging adults. I’ll then explain what you can do, to minimize these problems.
Six Common Medication-Related Problems in Aging Adults
Here are the most common problems that I see:
- Side-effects affecting thinking and balance. Although all medications can cause side-effects, quite a few commonly used drugs are known to make thinking and balance worse in aging adults. These include:
- Drugs in a class known as “anticholinergics,” which includes drugs for overactive bladder, itching/allergy, vertigo, nausea, and certain drugs for nerve pain or depression. Diphenhydramine, or Benadryl, is a commonly used anticholinergic that’s often included in over-the-counter sleep aids and PM-version painkillers. (Wondering how to spot these medications? I have a link to a great list of anticholinergics in this post.)
- Sedatives and tranquilizers, which are often prescribed for sleep or for anxiety. Examples include zolpidem and lorazepam (brand names Ambien and Ativan, respectively).
- These drugs can increase fall risk, or can provoke confusion. Geriatricians commonly recommend stopping or reducing the dosage of these drugs. For more information about four types of medication that affect memory, see here. For a list of medications that increase falls, see “10 Types of Medications to Review if You’re Concerned About Falling“.
- Symptoms persisting despite drug treatment. Many older people are started on a drug for a certain symptom, such as pain, heartburn, incontinence, or depression. But because primary care visits tend to be busy, it’s easy for doctors — and even patients — to postpone following up on the symptom indefinitely. (Many symptoms would benefit from non-drug treatment too, but that’s another issue.)
- In many cases, a “starter dose” is prescribed, but is not adjusted.
- Older adults may end up with the risks and burden of taking a drug — including the cost of the drug — while not getting much benefit from the drug.
- Geriatricians usually try to make sure that all drugs for symptoms are serving a useful purpose in improving well-being or quality of life.
- Drug interactions. This is one of the reasons polypharmacy can be so risky: some drugs tend to interact with others. A frequent source of problems is warfarin, a commonly-used blood thinner, which can interact with antibiotics as well as with other drugs. (Despite its risks, it’s often appropriate to prescribe warfarin to an older adult.)
- Warfarin is one of the most common causes of medication-related hospitalizations in older adults.
- To reduce the risk of serious problems, one may need to apply extra care in monitoring warfarin effect (via the prothrombin blood test) and extra care in checking for interactions when a new drug is prescribed. For more on using warfarin safely, see this article.
- Side-effects due to a strong effect of drugs on the older person. Examples of this include:
- Blood pressure medications at a dose that brings blood pressure much lower than the goal blood pressure. This can result in lightheadedness, or even falls, when an older person stands. (See this post and this post for my recommendations on safer managing of blood pressure in the elderly.)
- Blood sugar that is pushed quite low by diabetes drugs. Low blood sugar episodes can cause falls and have been linked to faster cognitive decline. Drugs that lower blood sugar are involved in many medication-related hospitalizations.
- Burden of scheduling and taking medications. Many older adults end up with several pills to take at several different times per day. At a minimum this is often a hassle; at worst it becomes a serious drain on quality of life.
- Some older adults are unable to take all their medications properly. Depending on which medications are missed, this can cause serious effects on an older person’s health.
- Cost of medications. Even with prescription drug coverage provided by Medicare Part D, the monthly costs of medications can be high. This is a burden for older adults, who often have limited financial resources.
- It can also cause people to skip taking certain medications, or not fill prescriptions for more expensive medications (such as inhalers).
There are of course many other medication-related problems that can occur, especially when hospitalizations or multiple doctors are involved. But the ones above are especially common when it comes to the primary care of aging adults.
What You Can Do
In an ideal world, every older adult would have access to a reliable process for reviewing medications, ensuring that the benefits outweigh the risks and burdens, and monitoring for side-effects and problems.
However, as many of you know, our healthcare system is not yet ideal for aging adults. So if you are caring for an older person and want to be proactive about checking on medications, here are some specific things you can do:
- Learn about the Beers List of Potentially Inappropriate Medications for Older Adults, and see if your older relative is taking medications on the list. This document includes a comprehensive list of “anticholinergic” drugs, and also lists other medications that are especially risky for the elderly.
- Don’t panic if you discover that an older person is taking a medication on the Beers list. Do plan on discussing with the doctor. You’ll want to understand why the benefits are likely to outweigh the burdens, and you can also ask if a lower dose is possible.
- You can also review “Ten Medications Older Adults Should Avoid or Use with Caution,” authored by the American Geriatrics Society. This document highlights ten especially commonly used medications that can often be stopped or reduced.
- If you need help spotting risky medications, consider asking a pharmacist for assistance.
- Make a comprehensive list of all medications being taken. Include prescription drugs, over-the-counter drugs, and herbal supplements. Then, for every drug being taken, make sure you and your older relative understand:
- The purpose of taking the drug. Ask yourselves if the drug seems to be serving its purpose. If you aren’t sure, plan to ask the doctor. If it’s a drug to manage a symptom such as pain, consider how the symptom seems to be doing. If the doctor hasn’t reassessed the symptom lately, or if the symptom is still bothersome, you’ll want to discuss with the doctor.
- If there are alternatives to taking the drug. Especially when it comes to treating symptoms, there are often non-drug alternatives that can and should be considered. For instance, certain types of counseling can be effective for depression and anxiety. Physical therapy can help treat some forms of pain. Pelvic floor exercises and timed toileting can reduce incontinence.
- If a lower dosage is possible. In general, the risk of side-effects and problems goes up with higher doses of medication. Consider asking if a lower dose is possible for any of the medications.
- Ask your health providers about “deprescribing”. Deprescribing means reducing or stopping medications that may not be beneficial or may be causing harm. It’s second nature to geriatricians, but now other primary health providers are also being encouraged to do this with older patients, to reduce the risks associated with polypharmacy.
- Randomized clinical trials have proven that giving older adults an informative brochure about their risky medications, along with a deprescribing plan to discuss with their doctor, does lead to actual deprescribing.
- Learn more here: Deprescribing: How to Be on Less Medication for Healthier Aging.
- If you’re concerned about drug-drug interactions, have the medication list checked for possibly dangerous interactions.
- Don’t forget to include any over-the-counter drugs or supplements when you check for interactions.
- You can use an online drug interaction checker such as this one, or ask a pharmacist for help.
- If you identify a potentially problematic interaction, let the doctor know as soon as possible. But don’t stop the medication on your own, as that can be dangerous too.
- If cost is an issue, ask the doctor about options for reducing the medications, or at least switching to less expensive alternatives.
- For instance, stopping a medication that is not working well for a symptom can help reduce drug costs.
- If medication is required for a given problem, such as very high blood pressure, ask if there is a cheaper medication available.
- Pharmacists may be able to offer suggestions regarding less costly alternatives, or other ways to modify the medication plan.
- If taking medications on schedule is an issue, ask the doctor for help simplifying and streamlining the daily medication plan.
- For drugs taken several times a day, there may be a once-a-day option.
- Or ask whether a drug can be stopped, and a non-drug treatment tried instead.
- Pharmacists can often recommend ways to safely adjust when and how medications are taken.
- Keep the doctors well-informed about your relative’s medications and medication use. In particular, help the doctors avoid these two common pitfalls:
- Confusion as to what has been prescribed by other doctors. Most seniors see multiple doctors, and hospital stays can create additional changes to the medication list. Don’t assume that doctors have an up-to-date list. (They almost never do!) Instead, bring an up-to-date list every time you see the doctor, or better yet, bring the bottles along too. Don’t forget to include supplements and over-the-counter drugs.
- Confusion as to what the older person is actually taking. If your relative hasn’t filled a prescription due to cost, or isn’t taking a medication for any reason, be sure to let the doctor know this. This is especially important if the older person has had concerns about side-effects.
By implementing some — or ideally all — of the steps above, you can help make sure that an older person gets the most benefit from medications, while minimizing the risks and burdens.
For more on medication safety, see “How to Review Medications for Safety & Appropriateness,” or see my Medication Safety topic page.
This article was last updated by Dr. Kernisan in August 2023.
Munawar A. Saeed says
1. I find your page exceptionally good. Do you know someone with similar credentials and interests in the Washington metropolitan area or in Richmond Va area, whom I can visit.
2. I am 81, in good health and no serious disease except COPD which is being treated under the direction of an excellent pulmonologist (Guita Bakhshi).
3. I do take vitaminD 2000 and my present blood level of Vit D is about 42. I understand that you recommend no more than 1000 daily. Why?
Leslie Kernisan, MD MPH says
Thank you, I’m glad you find the site helpful.
I cannot provide specific recommendations or referrals, but for suggestions on finding geriatrics care, see here: How to find geriatric care — or a medication review — near you
Regarding vitamin D, I explain my thinking here: Vitamin D: the Healthy Aging Dose(Plus Answers to 7 FAQs).
As I explain in the article, most people probably don’t need their levels checked and a daily supplement of 1000 IU is reasonable. I also write “My own practice is to caution patients if they are taking daily vitamin D supplements of more than 2000 IU/day in the absence of documented deficiency.”
Dr. Joy Poskozim says
Thank you for this very informative article! I see a lot of geriatric patients on the dental level who are keeping their teeth longer but now are suffering from late-stage tooth decay due to the insidious side effect of dry mouth. Since I go into a lot of homes, assisted living and skilled nursing facilities to treat seniors, it still astounds me how little is known about dry mouth and the numerous products that are safe and effective. Thank you!
Leslie Kernisan, MD MPH says
Yes, anticholinergic medications often cause dry mouth and this can affect teeth and other aspects of oral health. Great that you are providing dental care in people’s homes.
Erica Mercado says
Hello I’m new to this site… I’m a new pca worker haven’t got a client just yet…I have 2 questions what can I do if I think my client is dehydrated…also if my client gets dizzy when standing up what can I do to help
Nicole Didyk, MD says
Hi Erica and thanks for working with older adults! Your questions may be related, whether you realize it or not…dizziness upon standing can be a symptom of dehydration, due to a drop in blood pressure. Read more about blood pressure changes here, and about dehydration here.
Basit says
Doctor should have to explain each and every thing about the medicine so that patient can not take any kind of harm.
Noreen says
I am approaching 80 and do not trust doctors or medication after having illness undiagnosed. I stopped going and when I do go once a year or if something serious comes up, I will not weigh, do BP measurement or have physical. I monitor my BP and bring electronic record.
I take no medications unless I have an occasional UTI. I find that medical personnel want to control seniors with unnecessary drugs. So you can drug your senior friends or family, but just stay the f away from me. I have my faculties and am nowhere near tob being senile. My mother was highly intelligent and veey sharp when she died. She had COPD from smoking (born 1921 when govt promoted smoking) and was not on high BP meds. They had her on oxygen which I believe killed her lungs.
So, at my stage of life, I prefer few if any medical personnel involved in my life. If you are sick or coughing, do not come near me.
Nicole Didyk, MD says
Thanks for sharing your perspective.
e-Patient Dave says
I’ve just been introducing your show and the Beers List to another audience. Thank you so much for this resource!
Question: for the life of me I can’t find a single searchable web page or PDF for the 2015 criteria, so you can simply type in the name of a med! There’s a 2012 version in this PDF, but not 2015. Help??
Leslie Kernisan, MD MPH says
Thank YOU for helping to spread the word about the Beers List!
Yes, I agree that it’s been harder to find a PDF summarizing the 2015 Beer’s criteria. The Beer’s criteria page at HealthinAging.org is providing several different lists instead of one comprehensive document.
I think the only option right now is to find a PDF of the actual Beer’s criteria update journal article published in the Journal of the American Geriatrics Society. That is usually behind a paywall, but some sites have posted the article as a PDF, such as here. Hope this helps!
Jenny says
Hi,
I always thought that taking different kinds of medicines at the same time can cause harm but every time I ask a doctor about it, they usually just say it’s fine. Maybe with the kind of pills, it was okay, but them not explaining it properly can give a wrong assumption to people. They should explain this better to avoid further damage to the patient. Thanks for sharing!
Leslie Kernisan, MD MPH says
Doctors are often very busy, and so they don’t explain things as carefully as they might. Research shows that the risk of having a dangerous medication side-effect or interaction goes up, when people take more different types of medications.
If you are concerned about possible drug interactions, talk to a pharmacist and/or use an online drug interaction checker.
It’s also best to minimize the total number of medications being taken. I explain how to do this here:
How to Review Medications for Safety and Appropriateness
Carolyn says
My name is Carolyn and I am 85 years old. My doctor prescribed TRAZODONE. What is one tablet per day. I nave been taking for about 5 years what is it used for?
Nicole Didyk, MD says
Hello and thanks for your question.
Trazodone is a selective serotonin reuptake inhibitor (SSRI) and at lower doses like 25-50 mg, it can help with insomnia, specifically with helping to fall asleep. At higher doses, trazodone is an antidepressant, but not used commonly any more.
I don’t like to use sleeping pills on a long-term basis, if at all. Often they stop working and an older person just gets side effects without the benefits. You can learn more at this website: http://www.mysleepwell.ca. Or check out this article: https://betterhealthwhileaging.net/top-5-causes-sleep-problems-in-aging-and-proven-insomnia-treatments/
Lauren B says
Thank you – nice article. Very practical and actionable advice. Indirectly, the article highlights the need for seniors to have an advocate to assist with keeping their medications safe.
Leslie Kernisan, MD MPH says
It is very easy for mishaps to happen with medications, so yes, it’s always a good idea for an older person to have someone else routinely check on medications. I think if this were treated as routine rather than a sign that a person “needs help,” more older adults would be amenable.
Lee says
We had that problem with our Mom. She was skipping 2 or three days and then playing “catch up” by taking 4 doses at one time. We got her a smart pill box. Not the old fashion dumb pill box and replaced it with a smart pill box with flashing and beeping reminder. We load it for her and set the alert and the pillbox does the rest. Great idea
Leslie Kernisan, MD MPH says
Automatic pill dispensers do work for some families. Usually another family member has to be available to fill such pill boxes. It can also be tricky to make sure that any medication changes prescribed by doctors are implemented with the pill dispenser.
I recommend people look on Amazon to see different options and the customer reviews.
lee says
we got our 1 years old Mom a Med-Q pill box. It lights up the day holding the pills to take. The alarm repeats every 30 minutes until she takes them. It has worked great for forgetting .
lee says
you need to look at med-q pill box. It is great
garima garg says
Ms Leslie
i quite agree with you our healthcare system is not ideal especially for aged patients in india. I am a pharmacy professional and still unable to comprehend the number of medicines prescribed to my grandmother(85 yrs) , also some are very similar in there packaging also labeling are conventional which she cannot read . I think there is a major need to revamp our dosage designing especially for older patients. your article was very helpful. thanks
Leslie Kernisan, MD MPH says
Thanks for your comment. Yes, it’s still too common for too many medications to be prescribed, and then the dosages and names are often confusing.
As described in this NYTimes article, a “universal medication schedule” approach could help. Hopefully we will see systematic improvements soon, whether in the US or in India.
Emily Kristina says
Nice Post. Aging is the process we can not stop or escape from it. Everyone is going to age someday. The main thing which is important is aging gracefully with beautyful skin till the end.
Karen D. Austin says
Great post about medication concerns. Thanks for taking the time to share this information on your blog.
Leslie Kernisan, MD MPH says
Thanks for visiting the blog & glad you find this information useful. We are trying to get all health professionals to watch for these problems, but seems it can’t hurt to encourage family caregivers to keep an eye out as well.
Angie Hoth says
Thanks for the wonderful review of important drug-related problems in aging adults! The suggestions for seniors and caregivers are invaluable yet practical. And important in strengthening the partnership between health care users and providers. #lovegeriatricians #safemeduse @iodine
Leslie Kernisan, MD MPH says
Thanks for this comment. Love those hashtags! Although I might propose #lovegeriatrics, as I have this theory that geriatrics is an approach to healthcare, and can be practiced by anyone & everyone concerned about an older adult. After all, most geriatric care will have to be delivered by non-geriatricians…we are just the nerds who have done some extra time studying the approach 🙂
Carol K says
I tried to find a geriatrician in Salem, Oregon (the capital!), and the closest ones are in Eugene and Portland. There are only 5 or six in the entire state of Oregon. My doctor states on his practice’s website that one of his ‘special interests’ is geriatrics. So far, so good!
Leslie Kernisan, MD MPH says
Yes, unfortunately it can be quite hard to find a geriatrician who is taking new patients or available for consultations.
I share some suggestions as to how to find one here: How to find geriatric care — or a medication review — near you.
Good luck!