Which medications should older adults avoid?

Types of medications that older adults should avoid

Below is a list of eight types of medication that older people should avoid, or at least be careful when taking, due to potentially adverse outcomes:

1. Anticholinergics

These medications are used to treat various conditions, including allergies, overactive bladder, and Parkinson's disease. They work by blocking acetylcholine, a neurotransmitter, which is involved in many major body functions in the central nervous system (CNS).

Research indicates that the benefits of these drugs are outweighed by the adverse effects they cause in older people. ^[1] Older adults with Parkinson's disease should to explore alternative forms of treatment to anticholinergic drugs due to their adverse cognitive effects. ^[2]

Adverse effects can include dry mouth, blurred vision, constipation, delirium, and confusion. Some research suggests a link between long-term use of anticholinergics and an increased risk of cognitive decline and dementia. ^[3]

2. Non-steroidal anti-inflammatory drugs (NSAIDs)

NSAIDs, such as ibuprofen, are often used to manage pain and inflammation, but they can increase the risk of gastrointestinal bleeding, ulcers, kidney problems, and cardiovascular events, especially if taken regularly or in high doses. ^[2]

Older adults are more susceptible to these risks due to age-related changes in kidney function and the gastrointestinal tract. NSAIDs are particularly hazardous for patients with cardiac disease or renal dysfunction. ^[4]

Lower-risk alternatives, such as acetaminophen or topical diclofenac gen, should be used when possible. If NSAIDs are used, the lowest possible dose ought to be administered, and their course should be monitored regularly. ^[2]

3. Tricyclic antidepressants (TCAs)

While effective for treating depression, tricyclic antidepressants can cause side effects such as sedation, dizziness, and orthostatic hypotension (a drop in blood pressure upon standing). These effects can increase the risk of falls, fractures, and other accidents in older adults.

Selective serotonin reuptake inhibitors (SSRIs) and mixed reuptake inhibitors, such as serotonin-norepinephrine reuptake inhibitors (SNRIs) are as effective as TCAs and cause fewer side effects. ^[2]

However, all antidepressant use ought to be monitored closely in older people as they can all increase the risk of falls and hyponatremia, or low sodium levels. ^[2]

4. Anticoagulants

Blood-thinning medications like warfarin or direct oral anticoagulants are used to prevent blood clots. However, in older adults, dosages need to be carefully managed to avoid bleeding complications, particularly in people with diminished renal function. ^[2]

Drug interactions are common with warfarin so extra monitoring is required if a patient is taking any other medication alongside warfarin. ^[2] Regular monitoring of blood clotting factors is essential.

5. Benzodiazepines

If deemed medically necessary or safe, benzodiazepines can be prescribed for anxiety and sleep disorders. However, they can cause dizziness, drowsiness, and cognitive impairment, which can increase the risk of falls and accidents in older adults. ^[2] These drugs can also be habit-forming, leading to potential misuse or dependency.

First, insomnia should to be treated with non-pharmacologic measures for as long as possible, such as cognitive-behavior therapy, sleep hygiene, caffeine avoidance, and bedtime modification. ^[2]

If these measures fail, short-term use of a nonbenzodiazepine hypnotic, such as zaleplon, zolpidem, or eszopiclone is an option. These should be taken in extremely low doses in older adults and closely monitored by a medical professional. ^[2]

6. Antipsychotics

These medications are sometimes prescribed to manage behavioral symptoms associated with dementia. However, antipsychotics have been linked to an increased risk of stroke, heart events, and death in older adults with dementia. Their use should be carefully considered, and non-pharmacological approaches should be explored first. ^[2]

Antipsychotics should only be used to treat psychotic disorders in older people. The starting dose ought to be about a quarter of a standard adult dose and should be increased intermittently with frequent monitoring for any complications. ^[2]

There are numerous risks in using antipsychotics in the treatment of older people and these should be outlined by a doctor to a patient and their prospective family before beginning treatment. ^[2]

7. Diuretics

Diuretics are often prescribed as a first-line treatment for hypertension in older adults. They can help reduce excess fluid volume and lower blood pressure. Some research suggests, diuretics are over-prescribed in older adults and should not be used on a long-term basis. ^[4]

Older adults may experience decreased kidney function with age, which can affect how the body handles medications. Careful dosing and monitoring of kidney function are important to prevent over-diuresis and kidney injury.

Additionally, diuretics can potentially lead to dehydration or low blood pressure, which can increase the risk of falls in older adults. It's important to monitor hydration status and blood pressure regularly to minimize this risk.

8. Medications with sedative effects

Any medication that causes drowsiness or sedation can increase the risk of falls and accidents, especially in older adults who may already be at a higher risk due to age-related changes in balance and coordination.

Other considerations

In addition to these specific classes of medications, it's important for older adults to be mindful of potential drug interactions.

Older adults often take multiple medications for various health conditions, which can increase the likelihood of interactions that could amplify side effects or reduce the effectiveness of certain drugs.

To ensure the safety and well-being of older adults, healthcare providers should carefully evaluate the potential risks and benefits of each medication, taking into consideration the individual's overall health, medical history, and other medications they may be taking.