Is Your Doctor Prescribing Inappropriate Medications?

Have you ever heard the expression: “Seatbelts save lives”? This public service announcement became popular in the 1980s. It helped increase the use of seatbelts in private vehicles. By the mid-1990s, most states required their use by law. People who failed to buckle up could be ticketed and fined.

Although airplanes were equipped with seatbelts in the 1920s, it wasn’t until the early 1970s that passengers were required by law to fasten seatbelts during takeoff and landing. Anyone who doesn’t comply could be fined.

The Beers List of Potentially Inappropriate Medications:

In 1991 geriatrician Mark Beers, MD, published the first list of potentially inappropriate medications for older adults. It listed medicines that might put older patients at risk for falls, fractures, confusion, constipation or urinary problems.

Over the years, researchers have updated the “Beers Criteria.” Today, the goal is to reduce adverse drug reactions in people over the age of 65. That’s because aging bodies do not process medications as effectively as younger people. Liver or kidney function may be declining. In addition, they also may be taking many more medications, increasing the risk for dangerous drug interactions.

Unlike seatbelts, though, no one is monitoring prescription practices. There are no penalties for doctors or pharmacists who prescribe and dispense drugs that may be inappropriate for an older person. An analysis published in JAMA (Jan. 12, 2026) demonstrates that, despite some progress, there is still substantial room for improvement.

The authors conclude

“Despite decades of guidelines cautioning against their use, many older adults receive potentially inappropriate CNS-active medications. Patients with cognitive impairment were more likely than those with normal cognition to receive such medications.”

What Are CNS-Active Medications?

Central nervous system (CNS) drugs include antidepressants that have anticholinergic activity, antipsychotics, barbiturates, benzodiazepine sedatives and sleeping pills. In the latest study involving almost 5,000 participants, roughly 16 percent or one out of six patients was receiving an inappropriate medication that could affect brain function. Some readers describe possible consequences of such prescriptions.

One wrote:

“I am an RN certified in gerontological nursing. When I was working in an urgent care clinic, a woman brought her elderly mother for evaluation because she had become so dizzy she needed physical support to keep from falling.

“On review of her medications, I found that her physician had ordered Librium to treat anxiety. This medication is on the Beers list of those that are inappropriate for the elderly. The daughter said that it was the only new medication, and the dizziness started after she took her first dose.

“I shared that with the urgent care physician, but he discounted it, telling me “It can’t be Librium–the dose is too low.” He told the patient and her daughter to continue the medication.

“Alarmed by the doctor’s instructions, I took a substantial professional risk by telling the daughter to not give her mother any more of the medication until she spoke with the prescribing physician. I feared the patient could suffer injury due to the effects of the drug.”

Family Members Worry About Potentially Inappropriate Medications:

We sometimes hear from family members concerned about problems with medicines. It is not a new situation. This person wrote to us more than ten years ago.

Q. My mom is on Detrol for a bladder problem and I fear that it is causing mental confusion. She is also on two blood pressure drugs (losartan and amlodipine) that make her dizzy. Last week she fell and injured her shoulder. Now she can’t lift her arm to brush her hair. What can we do?

A. As people grow older, the doses of blood pressure pills that once were just right may become excessive. Have your mother’s doctor review all of her medicines and eliminate any that are not essential. A fall caused by dizziness can be life threatening. Even if it is less serious than that, it could have an impact on her quality of life, as you are witnessing.

Detrol (tolterodine) and other bladder drugs may contribute to forgetfulness and cognitive decline. Dozens of prescription medications can also cause brain fog and are often inappropriate for senior citizens.

The US Is Not Unique in Prescribing for Older Patients:

Older people seem to be especially vulnerable to adverse drug reactions, according to a long-running study of 15 general practices in Ireland (British Journal of General Practice, Jan. 24, 2023).

Tallying Adverse Drug Reactions:

The investigators collected data over six years on 592 individuals who were at least 70 years of age. During that time, over one fourth of these volunteers experienced complications from their medicine. While most were mild, a considerable portion of moderate adverse drug reactions led to additional doctor visits or even hospitalizations.

Common side effects included digestive distress, dry mouth, headaches, dizziness and drowsiness. More serious reactions included confusion, electrolyte imbalance and susceptibility to bleeding.

People taking the most medications (“polypharmacy”) were three times more likely to experience an adverse event. We get irritated when experts refer to polypharmacy as if it were the patient’s fault. Most older people taking multiple meds have several doctors prescribing these pills. What steps can prescribers take to address the problem?

“Brown Bag” Check-ups:

The authors of the Irish study recommend regular medication reviews for older patients. We agree completely. Sometimes a clinician will accept an appointment for a “brown bag” consultation. The patient puts all their bottles, including vitamins and OTC pills, into a brown paper bag and takes it to the office so that the expert can look for duplication. Then the health professional must meet the big challenge: deprescribing carefully.

Are Seniors Taking Inappropriate Medications?

Older people are more susceptible to adverse drug reactions in part because their bodies are less efficient at handling medications. There are also certain medicines that have been deemed inappropriate for the elderly. The American Geriatrics Society offers prescribers a list of these. It is The American Geriatrics Society (AGS) Beers Criteria® (AGS Beers Criteria®) for Potentially Inappropriate Medication (PIM) Use in Older Adults.

When older people seek emergency care, clinicians have the opportunity to evaluate medications and deprescribe high-risk medications (Clinics in Geriatric Medicine, Nov. 2022). Utilizing the Beers list and a screening tool of older people’s prescriptions (STOPP) cut down on medicines that may be especially likely to cause adverse drug reactions (Clinics in Geriatric Medicine, May 2017).

Which Drugs Are Most Likely to Cause Adverse Drug Reactions?

We always worry when older people are taking anticholinergic medications. You can find a list here. Such drugs can lead to confusion and memory problems. Sometimes older people take diphenhydramine (Benadryl) either for allergies or to sleep. It is the “PM” in nighttime pain relievers such as Tylenol PM. They may not realize that this medicine could be causing constipation or dry mouth as well as brain fog. If they take certain old-fashioned antidepressants for mood or for insomnia, they may become dizzy upon standing up. Such drugs and benzodiazepines like diazepam (Valium) or alprazolam (Xanax) can also contribute to confusion.

Learn More:

You can learn more about medicines that may be inappropriate for senior citizens in our free Guide to Drugs and Older People. You may also want to listen to our podcast about cutting back on medications. It is Show 1066: How to Fight Overmedication with Deprescribing. Other podcasts that may be of interest is Show 1185: What Are the Risks of Too Many Meds? and Show 1366: How a Pharmacist Helps Doctors with Deprescribing.