Who Is Watching Out for Older People’s Medications?

As we get older, things change. We can see the gray hair cropping up, and try as we might, we can’t hide the wrinkles. (At least, not entirely.) Interior changes aren’t so visible, but aging also alters our ability to metabolize medicines. Kidney and liver function may become compromised, so that doses should be lowered. Doctors need to take extra care with older people’s medications. In some cases, that may mean using higher doses. At other times, physicians may need to lower the dose or deprescribe medications altogether.

Older People Get Better Protection from High-Dose Flu Vaccine:

A report in JAMA Internal Medicine suggests that older people who get high-dose influenza vaccine are better protected against infection. Over 300,000 Danish senior citizens participated in a study that randomized them to receive either high-dose or standard dose flu shots (JAMA Internal Medicine, Jan. 12, 2026). The investigation covered three flu seasons.

This analysis considered how well the vaccination protected against heart failure and other cardiovascular complications as well as influenza. Those who got the bigger dose had fewer hospitalizations for cardiorespiratory problems. People with diabetes also fared better on the high dose vaccine. In particular, those who had been dealing with diabetes for five years or longer were significantly less likely to get respiratory complications from flu if they got the high-dose vaccine.

Drugs upon Drugs:

One thing we need to remember is that older adults are more susceptible to some drug side effects. If a healthcare provider responds with a new prescription to treat that symptom, a person may end up with drugs to treat side effects of medicines prescribed for a side effect. (Experts call this a prescribing cascade.) Some of the extra medicines may affect a person’s cognitive capacity, as we see in this story from several years ago.

Who Is Watching Out for Older People’s Medications?

Q. I work in dementia care. My co-workers and I are all alarmed about the medications given to elders.

In care homes, we all know that when someone gets a new medication, a fall may not be far behind. We are used to elders arriving on 10 or even 20 different medications, none of which have been reviewed before. We’ve even seen someone arriving with three different depression meds, started at three different time periods with none of them being discontinued.

Neglect of Older People’s Medications:

In the world of elder care, alas, we see disgraceful neglect in the world of medications. It would be a really good idea for a pharmacist to be required by law to review an elder’s meds.

A. We have long suspected that too many older people are overmedicated. Nursing home residents and patients with Alzheimer’s disease are especially vulnerable. Thank you for sharing an insider’s perspective.

The more drugs senior citizens take, the more likely they will experience fatigue, forgetfulness, confusion, dizziness and falls. Family and friends should be vigilant and request a review of all medications on a regular basis. To make this easier, we offer our Guide to Drugs and Older People, which lists a number of drugs that are inappropriate for people over 65, along with our Drug Safety Questionnaire, to be filled out by the prescriber or pharmacist.

Because the consequences of overmedication can be so serious, including confusion or falls, it is imperative that we find better ways to offer oversight on older people’s medications.