Geriatric Medication Safety: How to Protect Elderly Patients from Harmful Drugs
Dec, 1 2025
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Every year, more than 177,000 older adults in the U.S. are hospitalized because of dangerous drug reactions. Many of these cases aren’t accidents-they’re preventable. The problem isn’t that doctors are careless. It’s that the body changes after 65, and most medications were never tested for people over 70. What works for a 45-year-old can be dangerous for an 80-year-old. And when someone is taking five, six, or even ten different pills, the risks multiply fast.
Why Older Adults Are at Higher Risk
As we age, our kidneys and liver don’t process drugs the same way. Muscle mass decreases, fat increases, and fluid balance shifts. That means a standard dose of a blood pressure pill or sleep aid can build up in an older person’s system, leading to dizziness, falls, confusion, or even kidney failure. One study found that seniors are 91% more likely to be hospitalized due to a bad drug reaction than younger adults. Polypharmacy-taking five or more medications-is common. About 40% of adults over 65 take at least five prescriptions. Many of these drugs interact in ways doctors don’t always catch. Take a patient on warfarin for atrial fibrillation, ibuprofen for arthritis, and a sleep medication. Each one is fine alone. Together? They raise the risk of bleeding, kidney damage, and falls. And the worst part? Many of these drugs are still prescribed routinely, even when safer options exist.The Beers Criteria: The Gold Standard for Safe Prescribing
The American Geriatrics Society (AGS) created the Beers Criteria® in 1991 to help doctors avoid harmful medications in older adults. It’s updated every three years, and the latest version came out in 2023. It lists 139 medications or drug classes that should be avoided-or used with extreme caution-in people 65 and older. Some of the most dangerous include:- Benzodiazepines like diazepam and lorazepam-linked to falls, confusion, and memory loss
- Anticholinergics like diphenhydramine (Benadryl) and oxybutynin-cause brain fog and increase dementia risk
- NSAIDs like indomethacin and ketorolac-can cause stomach bleeds and kidney failure
- Tramadol-now flagged for causing dangerously low sodium levels, especially when mixed with antidepressants or diuretics
- Aspirin for heart disease prevention-no longer recommended for healthy adults 70+ because bleeding risks outweigh benefits
The New Alternatives List: What to Use Instead
In July 2025, the AGS released something new: the AGS Beers Criteria® Alternatives List. This isn’t just about stopping bad drugs-it’s about replacing them with better ones. For example:- Instead of benzodiazepines for anxiety or insomnia, try cognitive behavioral therapy (CBT), sleep hygiene, or melatonin
- Instead of anticholinergics for overactive bladder, consider pelvic floor exercises or timed voiding
- Instead of NSAIDs for joint pain, use physical therapy, heat/cold therapy, or acetaminophen (with caution)
- Instead of antipsychotics for agitation in dementia, try environmental changes, music therapy, or structured daily routines
Why Computer Alerts Alone Don’t Work
Many hospitals use electronic health record (EHR) systems like Epic to flag risky prescriptions. But here’s the problem: the alerts fire for every patient over 65-even when the drug is clearly needed. One emergency physician in Boston told me her team overrides Beers Criteria warnings 65% of the time because the system doesn’t understand context. Warfarin for atrial fibrillation? It’s safe and necessary. But the system flags it anyway. A 2025 study showed that EHR alerts alone reduce risky prescriptions by only 22%. But when you add a clinical pharmacist to the team? The drop jumps to 37%. Why? Because pharmacists don’t just see alerts-they talk to patients, review all medications together, and know when to bend the rules.What Works in Real Hospitals
At the Mayo Clinic Rochester ED, a team of pharmacists, geriatricians, and ER doctors redesigned how medications are reviewed before discharge. They used the AGS Alternatives List and created simple checklists. In six months, they cut high-risk prescriptions by 38%. The University of Alabama at Birmingham did something similar. They assigned pharmacists to do full medication reconciliations for every older patient leaving the ER. Result? A 22% drop in 30-day readmissions due to drug problems. These programs didn’t happen overnight. They took 12 weeks of training, workflow changes, and buy-in from doctors. But the cost savings were clear: each avoided hospitalization saved the system an average of $12,000.
The Human Side: When Rules Can Hurt
Not every rule fits every patient. Dr. Joanne Schnur wrote in JAMA Internal Medicine that blindly following the Beers Criteria can harm frail older adults with limited life expectancy. If someone has advanced cancer and is in pain, stopping an opioid just because it’s on the list could cause unnecessary suffering. The key is personalization. A 92-year-old with dementia and no family support needs different care than a 70-year-old who hikes every weekend and takes no other meds. The Beers Criteria are a guide-not a law. Doctors need to ask: What’s the goal of care? Is this drug helping or hurting?What You Can Do
If you or a loved one is over 65 and taking multiple medications:- Ask your doctor: “Is this medication still necessary?”
- Ask: “Are there non-drug options I could try first?”
- Bring a full list of all medications-including vitamins, supplements, and over-the-counter drugs-to every appointment.
- Ask for a pharmacist consult. Many clinics now offer free medication reviews.
- Don’t stop a drug on your own. Some medications need to be tapered slowly to avoid withdrawal or rebound effects.
The Future Is Here-But It’s Not Everywhere
The tools to fix this problem exist. The Beers Criteria. The Alternatives List. CMS measures. Clinical pharmacists. But they’re not evenly distributed. While 78% of big-city trauma centers have formal geriatric medication safety programs, only 31% of rural emergency departments do. The demand is growing. By 2030, 74 million Americans will be over 65. The cost of medication-related hospitalizations is projected to hit $528 billion a year. We can’t afford to keep doing this the same way. The solution isn’t more pills. It’s better thinking. Slower prescribing. More conversations. And a system that puts the patient-not the protocol-first.What are the most dangerous medications for seniors?
The most dangerous medications for older adults include benzodiazepines (like lorazepam), anticholinergics (like diphenhydramine), NSAIDs (like indomethacin), opioids (like meperidine), and tramadol. These drugs increase the risk of falls, confusion, kidney damage, and dangerous drops in sodium levels. The 2023 Beers Criteria® specifically flagged tramadol and aspirin for primary prevention in those 70+ due to new evidence on risks.
Can I stop my elderly parent’s medication on my own?
No. Stopping some medications suddenly can cause serious side effects-like seizures from benzodiazepines or rebound high blood pressure from certain heart drugs. Always talk to the prescribing doctor or a pharmacist first. They can help you create a safe tapering plan if the medication is no longer needed.
What’s the difference between Beers Criteria and STOPP/START?
The Beers Criteria focus on identifying potentially inappropriate medications (PIMs) to avoid. STOPP/START does two things: it identifies inappropriate prescriptions (STOPP) and also flags medications that are missing but should be given (START)-like statins for heart disease or vaccines for pneumonia. Beers is more widely used in U.S. hospitals; STOPP/START is common in Europe and sometimes used alongside Beers for a fuller picture.
Why do hospitals keep prescribing risky drugs to seniors?
Many reasons: outdated habits, lack of time, fear of patient complaints, or not knowing about alternatives. Some doctors don’t realize aspirin is no longer recommended for primary prevention after 70, or that Benadryl can cause dementia-like symptoms. The AGS Alternatives List (2025) was created to fix this knowledge gap by giving clear, evidence-based substitutes.
How can I find out if my loved one’s meds are safe?
Ask for a medication review. Many pharmacies offer free services, and Medicare now covers annual medication therapy management (MTM) for people taking multiple chronic drugs. You can also use the AGS Beers Criteria® list (available at geriatrics.org) to check specific drugs. But the best step is to bring all medications-bottles, pills, supplements-to a geriatrician or clinical pharmacist for a full evaluation.
Eddy Kimani
December 2, 2025 AT 19:38The Beers Criteria are a godsend for geriatric pharmacotherapy, but the real bottleneck is implementation. EHR alerts are noisy as hell-65% override rates? That’s not clinician incompetence, it’s poor UX design. We need context-aware decision support, not static lists. The Alternatives List is the real innovation here-non-pharmacologic interventions as first-line? That’s systems thinking in action.
And let’s not forget the economic angle: $12k saved per avoided hospitalization? That’s not just clinical wins, that’s ROI on clinical pharmacy staffing. CMS Measure 238 should be mandatory, not optional. We’re spending billions on reactive care when proactive deprescribing is cheaper and safer.
The real barrier isn’t evidence-it’s inertia. Medical education still treats polypharmacy like a badge of honor, not a hazard. We need mandatory geriatric pharmacology modules in residency. Period.
Chelsea Moore
December 3, 2025 AT 14:47THIS IS WHY OUR ELDERLY ARE DYING IN HOSPITALS!!!
Doctors are just prescribing like it’s 1995!! Benadryl for sleep?!?!?! Are you KIDDING ME?!?!?!!
And aspirin?!?! For primary prevention?!?!?!! That’s like giving a toddler a chainsaw and saying ‘be careful’!!
It’s not just negligence-it’s MALPRACTICE!! And the system lets it happen!!
Who’s protecting our grandparents?!?!?! NOT THE DOCTORS!! NOT THE HOSPITALS!! NOT THE PHARMA COMPANIES!!
WE NEED A REVOLUTION!!
John Biesecker
December 3, 2025 AT 15:05man i just read this and it hit me like a ton of bricks 😔
my grandma was on like 8 meds and they never sat down with her to ask if any were still needed
she’d get dizzy and we thought it was just ‘getting old’ but now i realize it was probably the benzos and the ibuprofen playing tug-of-war in her kidneys
we got her off most of it and she’s been walking better since
why is this not standard? why do we wait for someone to fall before we rethink? 🤦♂️
also melatonin for sleep? i didn’t even know that was a thing. i thought it was just for jet lag lol
thank you for writing this. it made me cry a little. and also kinda hopeful.
Genesis Rubi
December 5, 2025 AT 01:56so now we’re supposed to trust some ‘geriatric society’ instead of real doctors who actually treat patients?
beers criteria? sounds like communist health care to me
in america we don’t let bureaucrats tell doctors what to prescribe
my uncle took tramadol for 10 years and he’s still hiking in the Rockies at 82
you think some PhD in a lab coat knows better than a man who’s lived with pain for decades?
and who even are these ‘clinical pharmacists’? are they licensed? do they have MDs? or are they just pharmacy grads with a clipboard?
we’re losing our freedom to choose what’s best for our bodies. this is slippery slope to government-run medicine.
and why are they pushing ‘music therapy’? is this the new woke agenda?
we need less theory and more real-world results.
Doug Hawk
December 6, 2025 AT 22:25the 37% reduction with clinical pharmacists is the most compelling stat here
it’s not about tech or guidelines-it’s about human interaction
pharmacists are the unsung heroes of geriatric care
they’re the ones who catch the interactions the doctor missed because they were rushing between 12 patients
they’re the ones who ask ‘what are you taking for your anxiety?’ and find out it’s diphenhydramine from the cabinet
they don’t just read the list-they talk to the person
the system needs more of them, not fewer
and yeah, the alerts are noisy-but that’s not the fault of the criteria, it’s the fault of how we’ve built the EHRs
we need smarter alerts, not fewer guidelines
and maybe, just maybe, we need to pay pharmacists like they matter
John Morrow
December 8, 2025 AT 16:40the entire framework is fundamentally flawed because it assumes a homogenous geriatric population. the Beers Criteria are a blunt instrument applied to a heterogeneous cohort with varying frailty indices, cognitive reserve, and life expectancy. the 2023 update attempted to introduce nuance, but the implementation remains binary: flagged or not flagged. this is reductionist medicine at its worst.
the Alternatives List, while commendable, still operates within a biomedical paradigm that ignores psychosocial determinants. cognitive behavioral therapy for insomnia? laudable in theory, but what about the 78-year-old widow with no transportation, no internet access, and no family support? the literature doesn’t account for structural inequities. this is precision medicine for the privileged.
furthermore, the 38% reduction in high-risk prescriptions at Mayo is statistically significant, yes-but is it clinically meaningful? what is the NNT? what is the cost-benefit ratio when you factor in pharmacist labor? and why are we not measuring long-term functional outcomes instead of just hospitalization rates?
the real issue is not prescribing-it’s underfunding of primary care. we are medicating symptoms because we refuse to invest in social care infrastructure.
Kristen Yates
December 9, 2025 AT 11:22I’m a nurse in a rural clinic. We don’t have pharmacists on staff. We don’t have EHR alerts. We don’t have time for 45-minute med reviews.
But we do have patients who come in with brown bags full of pills from three different pharmacies.
I sit with them. I ask what each pill is for. I write it down. I call the doctor. Sometimes we stop something. Sometimes we change it.
It’s not fancy. It’s not techy. But it saves lives.
Maybe the real solution isn’t new lists or new measures.
Maybe it’s just someone who cares enough to listen.
Saurabh Tiwari
December 9, 2025 AT 16:02interesting read
in india we don’t have this problem because most elderly take only 1-2 meds
and they use ayurveda and home remedies
but i see the point about polypharmacy
my uncle in the us was on 7 pills and he got confused all the time
we got him to stop 3 and he was like a new man
why do doctors keep adding pills instead of removing?
maybe they think more pills = more care
but it’s the opposite
less is more
👍
Michael Campbell
December 10, 2025 AT 06:32they’re hiding the truth.
pharma paid for the Beers Criteria.
they want you off the old drugs so they can sell you the new ones.
melatonin? patented. CBT? can’t be patented.
they don’t want you to know that.
they want you dependent.
ask yourself-why did they make tramadol a ‘dangerous’ drug right when the opioid lawsuits started?
it’s not about safety.
it’s about profit.
Victoria Graci
December 10, 2025 AT 18:28there’s something poetic about the fact that the most dangerous drugs for seniors are the ones we used to call ‘miracle cures’-benzos for anxiety, anticholinergics for allergies, NSAIDs for arthritis.
we thought we were helping.
we were just delaying the inevitable with chemical bandaids.
now we’re learning that the body doesn’t age like a machine that needs more parts.
it ages like a forest-some trees need thinning, not more planting.
the Alternatives List isn’t just a list of substitutes.
it’s a philosophy.
it says: sometimes healing isn’t about adding something.
it’s about removing the weight.
and letting the body breathe again.
Saravanan Sathyanandha
December 11, 2025 AT 01:09the approach described here is not merely clinical-it is humane.
in many cultures, including mine, elders are revered, yet we often neglect their pharmacological well-being.
the notion that a 92-year-old with advanced cancer should not be denied opioids because of a guideline is profoundly correct.
guidelines must serve the patient, not the other way around.
the emphasis on non-pharmacologic alternatives is not a rejection of medicine-it is its highest expression.
to treat pain with music, agitation with routine, insomnia with sleep hygiene-this is wisdom.
it requires time, empathy, and deep listening.
these are not luxuries.
they are the essence of care.
alaa ismail
December 12, 2025 AT 06:06my dad’s doctor just added a new pill last week
he’s 81
and he’s on 9 now
i didn’t even know half of them
gonna bring the whole bag next visit
thanks for the reminder
ruiqing Jane
December 13, 2025 AT 02:29I’ve been working with geriatric patients for 18 years, and this is the most comprehensive, compassionate, and actionable summary I’ve ever seen.
You didn’t just list drugs-you explained the why, the how, and the human cost.
And you didn’t blame the doctors-you showed the system that’s failing them.
That’s rare.
That’s powerful.
Thank you for writing this.
If you ever write a follow-up on how families can advocate for their loved ones, I’ll be first in line to read it.
You’ve given me new language to use with my colleagues.
And I’m not even a doctor.
william tao
December 13, 2025 AT 17:23While the data presented is methodologically sound, the underlying premise remains ideologically suspect. The conflation of statistical reduction in hospitalization rates with clinical efficacy constitutes a classic ecological fallacy. Furthermore, the elevation of non-pharmacologic interventions as primary modalities reflects a dangerous trend toward the deprofessionalization of medicine. The assertion that 'the solution isn't more pills' ignores the fact that pharmacotherapy remains the most evidence-based intervention for a majority of geriatric pathologies. The Beers Criteria, while well-intentioned, represent a form of bureaucratic paternalism that undermines physician autonomy and clinical judgment. This article, while eloquently written, ultimately serves as a manifesto for a healthcare system that prioritizes cost containment over clinical individuality.
Elizabeth Farrell
December 14, 2025 AT 03:34Reading this made me think of my mom.
She was on eight meds. One was for acid reflux. One was for sleep. One was for anxiety. One was for arthritis. Two were for blood pressure. One was for cholesterol. And one was for... I don’t even know what it was for.
I asked her doctor, ‘Is this all necessary?’ He said, ‘Well, she’s 84. She’s got a lot going on.’
That’s not an answer. That’s a cop-out.
So I took the list to a clinical pharmacist. We cut four. Two were useless. Two were dangerous.
She stopped feeling foggy. She stopped falling. She started cooking again.
It wasn’t magic.
It was just someone who cared enough to ask.
If you’re reading this and you’re caring for someone older-don’t wait for a fall. Don’t wait for a hospital stay.
Bring the bag. Ask the questions.
You might just give them back their life.
And you don’t need a degree to do that.
Doug Hawk
December 14, 2025 AT 15:38you said it better than i could
that line about 'you don't need a degree to do that'-that's the whole point
we make this so complicated
but really it's just: ask, listen, review, adjust
no app needed
just love
and a little courage