Medications play a central role in geriatric care, helping seniors manage chronic conditions, but they carry real risks. Side effects compound as more drugs are added, and overuse has been linked to increased falls and delirium among older adults.
The deprescribing movement offers course correction, though stopping medications too quickly can trigger withdrawal-like symptoms, allow previously managed conditions to resurface, and cause emotional distress for patients.
Nurses support medication safety by following the "five R's" of administration, confirming patient, medication, dose, route, and time, while nurse practitioners take the lead in strategic deprescribing, keeping older patients and caregivers informed and empowered throughout.
Medication safety is always a priority, but may simply not be on the radar for some younger individuals, as they are less likely to use medications daily. This changes with age, however, with over two-thirds of U.S. adults between the ages of 40 and 79 using at least one prescription drug and over one-fifth requiring five or more prescription drugs.
As older adults take more medications, the likelihood of adverse effects increases exponentially. Directions that may seem relatively straightforward when taking just one or two medications per day suddenly feel complicated when different drugs need to be consumed at different times and under different conditions.
The term ‘polypharmacy' describes the concurrent use of several medications, but this is often described in the context of complexity or confusion. This concern, although noteworthy, does not capture the full danger of poorly managed polypharmacy. If complexity gives way to avoidable medication errors, patients risk dangerous side effects.
Taken in the wrong dose or at the wrong time, medications can become less effective or can prompt adverse reactions such as dizziness or upset stomach. These reactions can range from uncomfortable to downright dangerous, with the most severe cases prompting dramatic changes in blood pressure or heart rate.
Research shows a clear link between polypharmacy and risk of hospitalization (and mortality) among seniors. Experts also reference harms caused by poor patient adherence, often in response to confusing instructions or dosing schedules.
Aging may be associated with higher prescription drug intake, but it's also worth noting that the impact of individual drugs can vary simply because the body processes medications differently over time. Metabolism, for example, can cause certain effects to last longer if the liver grows less efficient at breaking down medications.
The distribution of drugs may be further impacted by declining muscle mass or higher body fat; concerns that, although not always present in old age, become more likely over time.
Many adults successfully adhere to medication regimens for years without suffering problems — when issues begin to arise, they can escalate quickly. Therein lies the need for early identification, so that potential medication concerns can be addressed before 'cascades' of prescriptions and side effects are able to begin.
Prescribing cascades occur when adverse drug reactions are addressed by prescribing or recommending additional medications. This 'Band-Aid' effect may fail to resolve the underlying issue that caused the reaction in the first place, and, what's more, those additional drugs could prompt new reactions that are solved with still more drugs.
Issues with prescription drugs often emerge at points of transition, when seemingly minor miscommunications can be quickly amplified in ways that place patients at significant risk. For instance, specialist referrals or hospital discharges open opportunities for poor coordination, causing providers to update medications based on partial or outdated information.
The medication review aims to optimize the use of prescription drugs. During this process, healthcare providers may detect drug-related concerns and recommend interventions.
Elements of the medication review could include a prescription review (providing a basic overview of prescribed drugs), a compliance review (focused on medicine-taking behaviors), and a clinical medication review (revealing how medications align with current health goals and clinical challenges).
An effective medication regimen starts with knowing what and why each drug is prescribed. A detailed, updated list of all medications, including doses and frequency, should be tied to personal health goals. This list needs regular review as prescriptions change and some drugs may become unnecessary, increasing the risk of side effects without health benefits.
Each new prescription increases the potential for harmful interactions, with risks multiplying quickly once patients take three or more medications. Safety checks prompt clinicians to examine medication lists for high-risk combinations or duplicate therapies — a process supported by EHR-integrated technologies and structured frameworks like the Beers Criteria and Drug Burden Index.
Deprescribing can be advantageous for some seniors with complex medication regimens, particularly when those seniors have a history of adverse drug reactions. Candidates for deprescribing include patients experiencing cognitive decline or reduced liver function.
Deprescribing involves the intentional tapering of previously prescribed medications, particularly when those medications are deemed to prompt limited health benefits or to actively harm patients. This is warranted when there is a clear divide between the medication and the patient’s current goals. It's also worth exploring if safer alternatives are available.
With seniors, deprescribing becomes advisable as new drugs create a cumulative burden that substantially increases the risk of adverse events. Research shows that deprescribing limits the use of potentially inappropriate medications (PIMs), thereby limiting exposure to drugs that may carry disproportionate risks — particularly when those drugs offer little benefit.
Deprescribing is especially worth considering for drugs included on the Beers Criteria. Michael Steinman, MD serves as the Beers Criteria panel co-chair and clarifies that this tool offers a "starting point for a discussion." Steinman adds that these issues should be explored in the context of personal needs and priorities.
Tapering may be intended to prevent side effects but, in some situations, can prompt effects of its own. Seniors may have adapted to medications through the years, and, as a result, could experience significant discomfort or even the return of distressing symptoms once they stop using certain drugs.
Gradual adjustments may help, rather than going cold turkey. Careful monitoring is also essential, as withdrawal symptoms or other harmful effects can appear long after dose reductions.
Patients should drive the discussion surrounding deprescribing. Their preferences and risk tolerance must remain top of mind. Caregivers offer valuable context, as they are the most likely to notice changes in cognition or behavior. Working together, patients, caregivers, and clinicians turn deprescribing into a collaborative process that inspires trust while prioritizing patient-centered care.
While tapering can simplify complex medication regimens, certain drugs are more likely to impact patients when scaled back, or prompt negative side effects when prescribed in the first place. Areas of concern for senior patients include:
Over one-quarter of seniors experience falls every year; this is the leading cause of injury among older adults. Fall prevention is crucial because falls can trigger chain reactions and overall decline in health and independence. While many factors contribute to the rising risk of falls, certain medications can exacerbate this.
Sedatives, for example, can cause excessive drowsiness in older adults, along with confusion and slowed reaction times. These risks are further compounded by interactions with other medications that impact the nervous system.
Anticholinergics (often used in allergy medications) can contribute to cognitive or physical concerns known as the anticholinergic burden, cumulatively increasing the likelihood of confusion or delirium.
Treatments suitable for younger adults may be too aggressive for seniors. Diabetes medications can cause hypoglycemia if overused, while blood pressure drugs may lower levels excessively. Both scenarios increase the risk of dizziness, confusion, and falls. To prevent overtreatment, regularly review and adjust medications according to current health status.
Older adults have often been overlooked amid efforts to address opioid use disorder, but they can be uniquely susceptible due to differences in how drugs are metabolized or how chronic pain is experienced.
Alternative medications can help older patients manage pain without risking dependence or excessive sedation. Options highlighted by the Centers for Disease Control (CDC) include nonsteroidal anti-inflammatory drugs (NSAIDs), lidocaine patches, and even certain antidepressants.
Physical therapy is important because it gets at the root causes of chronic pain that medications often fail to address. Research suggests that physical therapy can disrupt the transition from acute to chronic pain, limiting the duration for which opioid medications are required and sometimes even reducing the need for them in the first place.
Adverse drug events (ADEs) occur when the use of medication prompts injury or other harmful consequences. According to the Centers for Disease Control (CDC), these events prompt 1.5 million people to visit emergency departments. ADEs often relate to the use of blood thinners, insulin, and antibiotics.
Medication reconciliation helps prevent ADEs by identifying omissions or duplicates that often cause harm. Transitions, such as admissions, discharges, unit transfers, or shift changes, increase the risk of medication errors, making regular reconciliation essential.
Patients should feel empowered to take a central role in preventing ADEs. This begins with educational strategies that introduce patients to key risks and help them watch for signs of trouble. Teach-back methods support active learning while confirming patient understanding; under this approach, patients are asked to explain critical health information in their own words.
Collaborative care limits the potential for readmission by improving monitoring and helping providers or caregivers pinpoint concerns before they have the chance to escalate. Pharmacists can help identify duplications, while primary care providers confirm that treatments remain relevant to patients' health goals.
Input from family caregivers should also be actively sought, as loved ones are more likely to observe patients in real time and notice potentially significant changes in behavior or functioning.
Medication safety plans bring many of the strategies discussed previously together to promote the safe use of medication. This means preventing harms associated with overprescribing while also maximizing the positive impacts of any medications that are used.
Medication plans use meticulous documentation to turn intentions into actionable strategies. Documentation confirms why certain medications are needed and how they play into the big picture of patient care. Documentation should clarify associated risks and anticipated benefits, outlining how specific medications will move patients towards their health goals.
All changes to medication regimens must be appropriately documented in patients' charts. Next steps should also be clarified, detailing, for example, how monitoring will proceed and when medications should be reassessed.
Medication plans are most effective when regularly examined and adjusted. Routine reviews encourage clinical professionals to scrutinize current regimens, confirming that they continue to meet patients' needs. Frequent reviews become even more important with age, as patient conditions can shift quickly alongside changes in mobility or cognition.
Learn to tailor care for different patient populations while promoting holistic treatment planning and safe medication use. At Indiana Wesleyan University, we highlight responsible medication practices while prioritizing evidence-based practice.
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Polypharmacy describes the use of several medications. In older adults, this increases the chance of side effects or even incidents such as falls. As the number of medications rises, the risk of harm increases as well.
Deprescribing involves the carefully planned and heavily supervised reduction of medications that are thought to cause harm or provide limited benefits.
Sedatives, anticholinergics, and pain medications can increase confusion and contribute to the risk of falls. Overtreatment may also prompt sudden and highly dangerous drops in blood sugar or blood pressure among seniors.
Medications should be reviewed during times of transition, including hospital admissions and discharges. Thorough reviews should also be conducted as new medications are prescribed or as clinicians pursue deprescribing strategies. Regular reviews catch duplications or outdated drugs, along with potential signs of adverse effects.
A core risk of deprescribing involves the return of problematic symptoms. This is why gradual tapering and close monitoring are so important. Withdrawal effects and the return of symptoms can be minimized through individualized deprescribing strategies that intentionally reduce doses one step at a time.
Caregivers can closely review medication lists, asking questions to confirm which medications are required and how they should be taken. Caregivers also help to keep medications organized while watching for symptoms and communicating concerns to providers.
