As we age, our bodies undergo changes that can affect how medicines work, so medication safety is a crucial part of care for people over the age of 65. Older adults commonly have more health problems and take more medicines than younger adults. More than 88% of older people take at least one prescription drug and more than 66% use three or more in any given month, according to the National Center for Health Statistics, United States (NCHSUS). Understanding common hazards and taking proactive steps can reduce the risk of medication-related problems. We educate our older clients about medications to avoid, and how to properly store medicines to keep them effective and safe.

The Beers Criteria Offers Guidance for Medication Safety

The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults helps health clinicians safely prescribe medications for people over 65. The American Geriatrics Society (AGS) revises what is also called the Beers list every three years. It details medications older adults should avoid due to how the drugs work in the body, certain health conditions a person has, and potentially dangerous drug interactions.

Here are a few common medications on the Beers list that can pose health hazards to people over 65.

● Sleep aids - Good quality sleep can be challenging for some older adults due to chronic health conditions, so they turn to over-the-counter sleep aids that come with health hazards. Most over-the-counter sleep aids contain the antihistamines diphenhydramine or doxylamine which have been known to interfere with the natural sleep cycle in a detrimental way. There are also prescription sleep aids that are on the Beers List for older adults as well that can cause compromised cognitive function, drowsiness, and falls.

● Certain diabetes medications - Some of the older drugs used to treat diabetes may cause older adults to be more susceptible to hypoglycemia, or low blood sugar. This condition can lead to confusion, dizziness, falls, and even death if not immediately treated.

● Certain blood pressure medications - Older adults are more sensitive to fluctuations in their blood pressure which can be hazardous. Even if they lose a little weight, clinicians may need to adjust the dose of the blood pressure medication to balance the change. The summer heat in Texas can be especially dangerous for people who are not well hydrated while taking blood pressure medicines. The combination can lead to low blood pressure resulting in blurred vision, trouble concentrating, nausea, dizziness, fatigue, and falls.

● Nonsteroidal anti-inflammatory drugs (NSAIDs) - These common over-the-counter medications taken for pain, fever, or inflammation may cause gastrointestinal problems and even gastrointestinal bleeds in older adults. They also can affect kidney function.

● Anti-anxiety medications and antidepressants - These are commonly prescribed to older adults to treat anxiety, panic disorders, and depression. They work by changing the way cells in the brain communicate with each other. Benzodiazepines are a class of drugs that may become addictive and cause impaired thinking and increased risk of falls. These medications include alprazolam, diazepam, and lorazepam.

● Opioids - Older adults can be more vulnerable to the adverse effects of opioids because of age-related changes in metabolism and improper dosage. This population often has more chronic pain issues and surgeries (hip and knee replacements), and taking opioids for the pain can lead to oversedation, cognitive impairment, respiratory depression, and even death. When necessary, opioids should be used conservatively with older adults and for a very short time period. The medicines should always be accompanied by a stool softener and combined with a laxative if needed.

Proper Storage of Medications for Older Adults

Medications may work effectively only if they are stored properly. If certain drugs are stored in the bathroom, the moisture in the room may affect them. So it is best to store them in a dry space at room temperature. Avoid leaving medications in vehicles, especially if the outside temperature is high. The heat may change their effectiveness. In cooler seasons and climates, store medicines so they won’t freeze. Some medicines need to be stored in the refrigerator and some must be kept in dark colored bottles protecting them from light. For example, always leave nitroglycerin tablets in the dark glass bottle in which they are dispensed. Older adults should avoid putting certain types of medicines in clear daily medicine dispensers since room temperature or exposure to light might impact how they work.

As we get older, we can have a more difficult time remembering what medications to take and when. Ask your doctor or pharmacist about the best possible medicine organizer for the certain drugs you take. There are also medication reminder apps that may help people remember when to take their medicines. Establishing a close relationship with a primary care clinician and pharmacist can benefit older adults as they work to manage medications during different life transitions.