Why Aging Changes the Way Medications Work

The body’s chemistry evolves over time. Liver and kidney function slow, muscle mass declines, and body fat composition shifts—all of which affect how drugs are absorbed, distributed, and eliminated. A medication that lingers longer in the system may lead to fatigue, confusion, or dizziness that younger adults don’t experience.

Another key factor is polypharmacy, or the use of multiple prescriptions simultaneously. More than 40% of adults over 65 take five or more medications each day, increasing the chance of drug-drug interactions or overlapping side effects. That’s why experts recommend periodic medication reviews, ideally with a pharmacist familiar with geriatric care.

The Beers Criteria: A Guideline for Safer Prescribing

Developed by the American Geriatrics Society, the Beers Criteria serves as a reference for healthcare professionals to identify medications that may be inappropriate for older adults. It’s not a “do not take” list, but a cautionary guide that encourages individualized decision-making. The key message: age changes risk, not necessarily the medication’s value.

The 7 Medications Seniors Should Discuss With Their Doctors

1. Benzodiazepines (e.g., diazepam, lorazepam, alprazolam)

Commonly prescribed for anxiety or insomnia, these drugs can cause excessive sedation, dizziness, or confusion in older adults. Studies link long-term use with increased fall risk and cognitive decline. Safer alternatives may include non-drug therapies such as sleep hygiene strategies or short-term melatonin use under supervision.

2. Anticholinergics (found in allergy, bladder, and sleep medications)

These can impair memory and increase the risk of delirium. Common examples include diphenhydramine (Benadryl) and certain bladder control drugs. Many clinicians suggest newer, targeted options with fewer brain effects.

3. NSAIDs (e.g., ibuprofen, naproxen)

While effective for pain, nonsteroidal anti-inflammatory drugs can increase the risk of stomach bleeding and kidney strain. Older adults may benefit from topical versions or lower-dose regimens monitored closely by a healthcare provider.

4. Muscle Relaxants (e.g., cyclobenzaprine, methocarbamol)

Often prescribed for acute pain, these drugs can cause drowsiness and increase fall risk. Physical therapy or localized treatments may offer safer long-term results.

5. Certain Diabetes Medications (e.g., glyburide)

Some older agents in this class can cause dangerously low blood sugar levels in seniors. Doctors may recommend newer medications with more stable glucose control and lower hypoglycemia risk.

6. Antipsychotics (for dementia-related behavior)

These should be used with extreme caution in older adults due to heightened stroke and mortality risk. Non-drug interventions—environmental adjustments, caregiver support, and behavioral therapies—are often more appropriate first-line approaches.

7. Sedative Sleep Aids (e.g., zolpidem, “Z-drugs”)

Though widely prescribed, they can impair balance and memory. Cognitive-behavioral therapy for insomnia (CBT-I) is emerging as a safer, evidence-based alternative.

How to Talk to Your Doctor About Medications

Discussing medication changes can feel intimidating, especially when a drug has been part of your daily routine for years. But these conversations are essential. Bring a complete list of everything you take—including over-the-counter drugs and supplements. Ask about dosage adjustments, safer substitutes, or non-drug strategies. Pharmacists can also perform “brown bag reviews,” examining all medications together to flag potential interactions.

Preventing Polypharmacy Problems

Simple steps can dramatically reduce risks:

• Keep a single, updated medication list.

• Avoid duplicate therapies (for example, two pain relievers with similar ingredients).

• Schedule annual medication reviews.

• Report any dizziness, confusion, or unusual symptoms immediately.

These habits help maintain independence and quality of life—without unnecessary side effects.