Here’s What You Need To Know About Your Meds If You’re 65 Or Older

Katie Mui
Katie Mui is on the Research Team at GoodRx.
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As we get older, our bodies start turning on us. Our blood pressure begins to rise, joints develop arthritis, and arteries start clogging up. We end up taking more and more medications. Some 90% of people over the age of 65 take at least one medication per week, and 40% take five or more. 1 in 6 people in this age group will inevitably experience a harmful side effect of a drug they are taking regularly.   

To prevent these sorts of adverse events, the American Geriatrics Society (AGS) developed a database called the Beers List to flag drugs inappropriate for people 65 years of age or older.

Why are some drugs dangerous for older people?

People in the geriatric group are twice as likely to experience medication side effects than younger people. That’s primarily due to three things:

  1. Our body composition changes as we age. We lose water and gain fat, so water-soluble drugs don’t dilute as well while lipid-soluble drugs nestle into our fat layers and are absorbed faster. In both cases, the concentration of the drug inside the body increases, which boosts the chances of side effects. With more of a drug circulating within the body, interactions with things like other drugs, supplements, certain foods, and alcohol are also more likely.
  1. Our liver and kidneys, two of the organs responsible for breaking down drugs, stop working as efficiently. When our metabolism decreases, drugs stay in our system longer, which can also lead to increased side effects.
  1. Older people tend to take more medications than younger people – and more drugs in the system mean higher risk of complications.

The Beers Criteria List

The Beers List, named after Dr. Mark Beers, was first released in 1991, with the most updated version being 2015. The list is meant for physicians prescribing drugs to older patients, but it’s also a good reference for patient education.

If you are 65 years old or above, or you’re looking after someone who is, it’s important to get a sense of what medications to avoid. You can look at the full list, which covers dozens of conditions and hundreds of medications, here. There is a surprising number of common medications on that list – including many that are available over-the-counter (OTC), which people generally assume are safer than prescription drugs.

Let’s take a closer look at some drug categories that are included in the Beers List 2015:

Cardiovascular drugs

Chronic high blood pressure (hypertension) is a common condition for older folks, with an estimated 64–79% of people over the age of 65 diagnosed with it. Doctors should check the Beers List when prescribing hypertension medications, though, because the drugs’ effects can go too far the other way, causing blood pressure to drop too low or slowing the heart down too much.
Included on the list:

Pain relief drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen are some of the most commonly used OTC meds. But older people should be cautious and use them sparingly as they can have bad side effects, like gastrointestinal bleeding. It’s well-documented that long-term use of NSAIDs can take a toll on the liver and kidneys of older patients, increase their blood pressure, and cause headaches or dizziness.
Included on the list:

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In an older post about OTC antihistamines, we mentioned that first-generation allergy relief drugs can have many side effects, including sedation, drowsiness, or dizziness – all of which can lead to falls. Anyone 65 years of age or older should be careful when taking these meds due to the increased risk of falls.
Included on the list:

Anti-anxiety drugs

Benzodiazepines (“benzos”) are commonly used to treat anxiety. Beers recommends older patients avoid this class of meds due to exacerbated side effects, including cognitive impairment, feeling tired or having delayed reaction time. If prescribed to older adults, clinicians will want to use the lowest therapeutic dose so there’s less of the drug in the system.
Included on the list:

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