Medications Most Likely to Cause Harm in Older Adults
January 14, 2025 2026-08-16 16:34Medications Most Likely to Cause Harm in Older Adults
Abrampah PharmD, BCGP, BCMTMS, SIDP-CASP, APh 
Medications Most Likely to Cause Harm in Older Adults
Several classes of medications pose a higher risk of harm in older adults due to increased sensitivity and potential for adverse effects. These include antidepressants, sleep medications, anti-anxiety medications, muscle relaxants, anti-seizure medications, antipsychotics, and opioid pain medications, among others. Additionally, anticholinergic medications, some blood pressure medications, and medications that lower blood sugar can also increase fall risk.
| Blood Thinners | Diabetes Medications | Opioids |
| Blood thinners such as Warfarin and Aspirin can cause severe bleeding, which can be life-threatening in older adults. | Diabetes medications such as insulin and sulfonylureas can cause hypoglycemia or low blood sugar in older adults, increasing risk for falls, fracture, confusion, seizures, and hospitalization. | Opioids prescribed or illicitly used to treat pain in older adults can be habit-forming, and can lead to sedation, falls, cognitive impairment, and motor vehicle accidents. |
Other classes of drugs have been shown to increase the potential for harmful adverse effects in older adults.
| Sedative Hypnotics | Over-the-Counter Drugs | Blood Pressure Medications |
| Sedative Hypnotics such as benzodiazepines (Example, Xanax, Ativan, Valium, and Ambien) and many sleep medications, as well as antidepressants, increase risk of falls, fractures, cognitive impairment, and other adverse effects in older adults. | Many commonly used Over-the-Counter Drugs, including bladder medications and antihistamines have anticholinergic properties. These medications can cause hallucinations, confusion, tachycardia, dry eyes, and other adverse effects, which can be more pronounced in older adults. | Blood pressure medications, especially when used at high doses or in combination, can lower blood pressure too much and lead to falls, cognitive impairment, and other adverse effects in older adults. |
| Antipsychotic Drugs | NSAIDs | Steroids |
| Antipsychotic drugs can lead to delirium, cognitive, drug-induced movement disorders, and metabolic disturbances in older adults. | Some NSAIDs, like indomethacin, have more harmful effects in older adults. They increase risk of bleeding and kidney damage. | Can increase the risk of falls. |
| Proton pump inhibitors (PPIs) | ||
| May increase the risk of bone fractures. |
Why Older Adults are More Vulnerable
- Older adults may have altered drug metabolism and excretion, leading to higher drug levels in the body.
- They may have more underlying health conditions that can interact with medications.
- Sensory changes and decreased cognitive function can make it harder to remember medication schedules or recognize side effects.
- Polypharmacy (taking multiple medications) increases the risk of drug interactions and adverse effects
Recommendations
- Consult with a healthcare professional to review all medications, including over-the-counter drugs and supplements.
- Be aware of common side effects and report any concerns to your doctor.
- Take medications as prescribed and avoid taking medications in combination without consulting a healthcare professional.
- Consider deprescribing (stopping unnecessary medications) to reduce the risk of adverse effects.
Disclaimer
The information provided is for informational purposes only and does not constitute medical advice. Always consult with a healthcare provider for personalized guidance on medication management.
