Five widely used medicines doctors say can become riskier after age 65

Here’s an important question to consider: are the medications you take every day truly helping, or might they be causing harm? As people age, the body’s response to medicine can change a great deal. A drug that caused no trouble in midlife may lead to serious problems later on. The point isn’t to alarm anyone; it’s to encourage informed decisions.

That is where the Beers Criteria comes in. Despite the name, it has nothing to do with alcohol. It is a medically reviewed guide created from the work of Dr. Mark Beers, a geriatrician who studied how medicines affect older adults. He first published a list of drugs that may be inappropriate for seniors, and the American Geriatrics Society has continued updating it regularly. The list is not an absolute ban on any medication. Instead, it helps patients and clinicians weigh risks and benefits and choose treatment plans that better fit an individual’s needs. (Based on the insights of Dr. Paul Zalzal and Dr. Brad Weening)

Key Takeaways

What is the Beers Criteria? A science-based list of medications that may not be the best choice for older adults because the risks can outweigh the benefits.
Why does it matter? Aging can reduce how efficiently the liver and kidneys process drugs, raising the chance of side effects such as falls, confusion, and organ injury.
What are some major concerns? Five common categories on the list include certain sleep medications (Z-drugs), anticholinergics, acid reflux drugs (PPIs), anti-inflammatory drugs (NSAIDs), and anti-anxiety drugs (benzodiazepines).
What should you do? Never stop a prescribed medication on your own. Use this information to talk with your doctor and pharmacist about whether your prescriptions should be reviewed.

Five Medication Groups Worth Reviewing With Your Doctor

Below are five of the most common drug classes found on the Beers Criteria. They are listed from five to one, with the final item being one of the best-known examples. The aim is awareness, not panic.

5. Z-Drugs (Zopiclone, Zolpidem)

Sleep can become harder to come by with age, which helps explain why so-called “Z-drugs” are widely used. They may help people fall asleep, but for older adults they can also cause heavy and lasting drowsiness. That becomes especially risky if someone wakes during the night to use the bathroom, since poor balance and grogginess can greatly increase the chance of a fall or hip fracture. These medications may also remain in the system longer than expected, leaving a person sedated well into the next day. Before turning to sleep pills, it is safer to try good sleep habits: keep the bedroom cool, dark, and quiet, avoid screens before bed, and steer clear of caffeine or alcohol in the evening.

4. Anticholinergics (e.g., Benadryl, Oxybutynin)

This group includes many over-the-counter and prescription medicines. Examples include antihistamines such as Benadryl for allergies or rashes, and drugs like oxybutynin for an overactive bladder. These medicines block acetylcholine, and while that may help one symptom, it can create problems elsewhere, especially in the brain. In older adults, anticholinergics can affect thinking, cause drowsiness, dizziness, confusion, and even delirium. They are also known to raise the risk of falls. For anyone with mild memory issues already, the effect can be much worse. Because these drugs are so common, it is worth asking a doctor or pharmacist whether a safer option exists.

3. Proton Pump Inhibitors (PPIs)

People with heartburn or acid reflux are often familiar with PPIs, including omeprazole and pantoprazole. These medications lower stomach acid and can be very effective, but long-term use in older adults raises concerns. One major issue is bone health: stomach acid helps the body absorb calcium, and reducing acid may interfere with that process. Over time, that can weaken bones and raise the risk of fractures. PPIs have also been associated in some older adults with confusion and other cognitive effects. If you take one, it is sensible to ask whether you still need it or whether the lowest effective dose for the shortest possible time would be enough.

2. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

This category includes familiar medicines such as ibuprofen, sold as Advil or Motrin, and naproxen, sold as Aleve, along with prescription-strength versions. NSAIDs are effective at easing pain, inflammation, and fever, but they can be much harder on older bodies. The risks center on three areas. First are the kidneys: NSAIDs can reduce kidney function and lead to fluid retention, high blood pressure, or even kidney failure in some cases. Second is the stomach: these drugs are well known for causing ulcers and bleeding. Third is the cardiovascular system: routine daily baby aspirin is no longer recommended for most people who have not already had a heart attack or stroke, because the bleeding risk can outweigh the heart benefit when used for primary prevention. A medicine that felt harmless in younger years may no longer be a safe choice later on.

1. Benzodiazepines (e.g., Valium, Ativan)

In earlier decades, benzodiazepines were commonly prescribed for anxiety and sleep. Names such as Valium and Ativan, along with many drugs ending in “-pam,” are in this group. They are now considered among the most concerning medications for older adults. Their sedating effects can severely affect balance and greatly increase the risk of falls. They can also cause memory problems, confusion, and broader cognitive impairment. Because older bodies break these drugs down more slowly, sedation can last much longer than intended, leaving a person groggy or mentally foggy for an extended period. Although they may have a limited role in carefully controlled situations, they are generally not a safe long-term solution for sleep in older adults.

Steps You Can Take to Improve Medication Safety

Learning about the Beers Criteria is only the first step. Here are five practical ways to protect yourself.

Do not stop any medication suddenly. This is the most important rule. If you recognize one of these medicines on your list, do not quit on your own. Stopping certain drugs abruptly can be dangerous, so begin by speaking with the clinician who prescribed it.
Talk openly with your healthcare team. Ask your doctor why you are taking the medicine, what the benefits and risks are for someone your age, and whether safer alternatives exist. Pharmacists are also valuable medication experts. Before using any over-the-counter product, check whether it is safe given your age, health conditions, and other prescriptions.
Request a yearly medication review. Make time at least once a year to go over your complete medication list with your doctor or nurse practitioner. Ask about every item: “Do I still need this?”
Use one pharmacy. Filling all prescriptions at the same pharmacy helps the pharmacist keep a full record of what you take, making it easier to detect harmful interactions between medications from different doctors.
Bring all medicines to appointments. Carry a current written list of every prescription, over-the-counter drug, vitamin, and herbal supplement you use—or bring the bottles themselves in a bag. That gives your clinician the clearest picture and helps apply the Beers Criteria to your situation.

Conclusion

As Sir William Osler famously said, “The person who takes medicine must recover twice, once from the illness and once from the medicine.” The Beers Criteria is meant to reduce that second burden. It is not an argument against medication; many drugs are essential and life-saving. Rather, it encourages respect for medicines and shared decision-making with your healthcare team. Look up the criteria from the American Geriatrics Society if you want to learn more, but most importantly, use the information to start a conversation. Know what you are taking, why you are taking it, and what the risks may be. When it comes to your health, staying informed matters.