Medication Risks in Older Adults — Falls, Cognitive Decline & Polypharmacy
Adults over 65 metabolise drugs more slowly, making standard doses potentially too high. Learn which medications are particularly risky for older adults and how to manage polypharmacy safely.
Why Medications Are Riskier in Older Adults
With age, liver and kidney function decline, so drugs stay in the body longer at higher concentrations. Body fat increases (affecting fat-soluble drug distribution) while body water decreases (increasing concentrations of water-soluble drugs). Older adults are also more likely to have multiple conditions requiring multiple medications — polypharmacy (taking 5+ medications) dramatically increases the risk of harmful drug interactions.
The Beers Criteria — Medications to Avoid in Older Adults
①Antihistamines (diphenhydramine, doxylamine): Cause confusion, urinary retention, constipation, and falls. Found in many OTC sleep aids and cold medicines. ②Benzodiazepines and Z-drugs (zolpidem): High risk of falls, fractures, cognitive impairment, and dependence. ③Tricyclic antidepressants (amitriptyline): Cause orthostatic hypotension, falls, and heart rhythm problems. ④Long-term NSAID use: GI bleeding, kidney damage, and cardiovascular risks are amplified in older adults. ⑤Long-acting sulfonylureas (glibenclamide/glyburide): Cause prolonged dangerous hypoglycemia.
Medications That Increase Fall Risk
Sleeping pills, anti-anxiety medications, blood pressure drugs, diuretics, antidepressants, and antihistamines all cause dizziness and orthostatic hypotension (blood pressure drop on standing), dramatically raising fall risk. Falls are a leading cause of serious injury and death in older adults. If you take these medications: rise slowly from sitting or lying positions, ensure adequate nighttime lighting, use non-slip mats, and consider a bed rail. Never stop these medications abruptly — work with your doctor to adjust the dose.
Managing Polypharmacy
Bring a complete list of all medications — prescription, OTC, and supplements — to every doctor's appointment. Ask for a medication review at least once a year, ideally with a pharmacist specialised in geriatrics. "Brown bag reviews" — bringing all your pill bottles in a bag to the pharmacy — are an effective way to identify duplicates and interactions. Never assume that because a drug was prescribed, it is safe to combine with everything else you take.
Kidney Function and Dose Adjustment
Many older adults have reduced kidney function even when they feel fine — it often shows no symptoms until significantly advanced. Drugs cleared by the kidneys (metformin, certain antibiotics, digoxin, NSAIDs) can accumulate to dangerous levels. Ask your doctor to check your kidney function (creatinine, eGFR) regularly and share the results with all your prescribers. Dose adjustments are often needed even when "normal" doses are prescribed.