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Medication Safety

Adults over 65 typically have more medical conditions and are prescribed more medications than younger people. Medication management can be complex and challenging. Age changes the way medications work in the body, which in turn increases risk of harmful side effects and medications interactions. The risks and benefits of each medicine must always be considered. Careful collaboration between patients, families, pharmacists, and physicians is necessary to ensure medication safety. 

Medicine Prescription
Risk Factors

According to the American Geriatrics Society, the biggest risk factors for harmful medication side effects are age >85, low body weight, six or more medical problems, impaired kidney function, nine or more total medications, 12 or more doses of medication per day, and a history of experiencing harmful medication side effects in the past. 

Medications Work Differently In Older People

Age may affect how a medication is absorbed, distributed, processed, and cleared from the body in many different ways.


For example, movement through the gut slows with age, which in turns slows absorption of oral medications. An older person may have a higher percentage of body fat, which means a drug that is absorbed by fat cells will take longer to reach its steady state and longer to be eliminated from the body.


The liver may have less blood flow in older age, which may interfere with the liver’s ability to break down the medication properly. Kidney function declines with age, which means the kidneys may not be able to get rid of the medicine effectively. 

Medications That Should Be Avoided or Minimized In Older People

These medicines have been shown to have more harmful side effects and medication interactions when taken by older adults. The American Geriatrics Society recommends avoiding these medicines if possible. If you are taking any of these medicines, have a conversation with your doctor about the risk and benefits, and work together to create a plan that works best for you. 

Sedating antihistamines

Sedating antihistamines such as diphenhydramine (Benadryl) and doxylamine (active ingredient in Nyquil) are often used to treat allergies or as an over-the-counter sleep aid. They are highly anticholinergic, meaning they block the normal function of a neurotransmitter called Acetylcholine. As a result, they can cause dry mouth, constipation, urinary retention, and confusion. This group of medicines should particularly be avoided in people with dementia as they can cause worsening confusion and delirium. These medicines are often added to over-the-counter medicines for sleep, cough, and cold, so be sure to avoid taking medicines that have “PM” or “Nighttime” in their names. 


This family of medicines prevents spasms of the bladder, intestines, or stomach. They are used to treat overactive bladder, irritable bowel syndrome, and motion sickness. Examples of antispasmodics are dicyclomine (Bentyl), hyoscyamine (Levsin), and scopolamine (Transdermscop). Like antihistamines, this class of medicines are also highly anticholinergic, meaning they can cause dry mouth, constipation, urinary retention, and confusion. They should especially be avoided in people with dementia or urination issues like enlarged prostate. 

Alpha blocker antihypertensives

This family of medications, including doxazosin (Cardura) and prazosin (Minipress), are used to treat high blood pressure. They work by dilating the blood vessels. However, as they dilate blood vessels, they often also cause dizziness, low blood pressure, and even fainting. Usually, there are other safer alternatives than can be used to treat high blood pressure in older adults. 

Antipsychotics in dementia

Antipsychotic medications such as haloperidol (Haldol), risperidone (Risperdal), olanzapine (Zyprexa), and quetiapine (Seroquel). This class of medication is associated with increased risk of stroke, faster cognitive decline, and death when used in people with dementia. These medications can be used to control behavioral problems of dementia, but should only be used if other safer options have failed AND if the patient is at risk of harming themselves or others. A risk vs. benefit discussion is highly recommended before starting. 

Benzodiazepine anxiety medications

Benzodiazepines, such as alprazolam (Xanax), lorazepam (Ativan), temazepam (Restoril),  and clonazepam (Klonopin) are used to treat insomnia and anxiety. Older adults are much more sensitive to the harmful side effects of these medicines. They increase risk of dementia, delirium, falls, fractures, and car accidents in older adults. In addition, when used regularly, they can be habit-forming. 

“Z-drug” sleeping medications

Drugs like zolpidem (Ambien) and eszopiclone (Lunesta) are hypnotics that are often used to treat insomnia. Similar to benzodiazepines, they increase risk of delirium, falls, fractures, emergency room visits, hospitalizations, and car accidents when used in older adults. Furthermore, research shows that they produce only minimal improvement in sleep. Talk to your doctor about safer alternatives to help you sleep. 

NSAID pain medications in high risk patients

NSAID pain medications such as ibuprofen (Advil, Motrin), meloxicam (Mobic), and naproxen (Aleve) should be used with caution in older adults. When used on a regular basis, they increase the risk of stomach ulcers and stomach bleeding in people who are over 75 or are taking other medications that increase risk of stomach bleeding such as steroids and blood thinners. In addition, NSAIDs can increase blood pressure, cause kidney injury and increase the risk of heart attacks. Talk to your doctor before taking NSAIDs. 

What You Can Do To Improve Medication Safety
Keep a medication list

Keep an up to date and organized list of your medicines. Make sure to include all prescriptions and over the counter medicines, even vitamins and supplements. Bring this list with you every time to see a healthcare professional. Better yet, keep it in your purse or wallet so you always have it with you. This will help your doctor and medical team have the information they need. 

Be aware of side effects

Ask your doctor about possible side effects of your medicines, especially when starting a new medicine. Write down possible side effects to watch out for, monitor closely, and tell your doctor right away if you do notice any side effects, even if they are mild. Talk to your doctor before starting or stopping any medication. 

Watch out for high risk medications

If you currently take or are considering taking a medication on the list above, have a conversation with your doctor about the risks and benefits. Ask if there are safer alternatives available. Work together as a team to create a medication regimen that’s as safe and effective as possible. 

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