The use of medications may present significant challenges to older adults. For example, we know that older adults process medications differently than younger people. As a result, older adults are often more sensitive to both the therapeutic and adverse effects of medications and may require lower doses of medications. Medications may have a wide array of adverse effects (also known as side effects), but older adults can be particularly impacted by medication-induced changes in cognition and balance. When a new symptom presents in an older adult patient, it is prudent to look first to any recent medication changes to see if the new symptom is a medication-related problem instead of a new disease process. The adverse effects of medications are listed in many general drug references.
Research has also shown that there are a number of medications that are potentially inappropriate for older adults to be using on a regular basis. There are many ways to evaluate medication appropriateness, but the list below developed by Dr. Mark Beers (last updated in 2003) is among the most commonly used.
Updated Beers criteria lists:
Original Beers criteria publication:
- Beers, M.H. (1997). Explicit criteria for determining potentially inappropriate medication use by the elderly. Arch Intern Med. 157, 1531-1536. Available online >>
Updating the Beers criteria for potentially inappropriate medication use in older adults:
- Results of a US consensus panel of experts. Arch Intern Med, 163. 2716-2724.
Available online >>
How to Try This video: The Beers Criteria for Potentially Inappropriate medication use in older adults
- Click on Geriatrics. Available online >>
General Drug Information References about Medication Use in Older Adults
A searchable drug information resource provided by the National Library of Medicine and the National Institutes of Health. Includes prescription and non-prescription drugs, herbs and supplements.
Geriatric Dosage Handbook
Semla, T.P., Beizer, J.L., & Higbee, M.D. (2000). Geriatric dosage handbook. Lexi-Comp.
Bressler, R. & Katz, M.D., (1995). Geriatric pharmacology. New York: McGraw-Hill.
Nelson, J.C. (Ed). (1997). Geriatric psychopharmacology. New York: Marcel Dekker, Inc.
Merck Manual of Geriatrics
Abrams, W.B., Beers, M.H. (Eds). (1995). Merck Manual of Geriatrics (2nd ed.). Whitehouse Station, NJ: Merck and Company.
Medicines in the Elderly
Armour, D., Cairns, C. (Eds). (2002). Medicines in the Elderly. London: Pharmaceutical Press.
Drugwatch.com provides information about prescription and over-the-counter medications and their associated side effects.
Medications may potentially interact with each other, over-the-counter medications, vitamins or natural supplements, or foods. As the number of medications used increases, the risk for one or more drug interactions also increases. All patients, but particularly older adults, should make sure that all healthcare providers have an up to date medication list including prescription, nonprescription medications, vitamins and natural products. Refer to the general drug information sources above for information about drug interactions.
Resources to Create Medication Lists and Manage Medications Safely
There are several websites that make resources available online to help patients and providers create medication lists and manage medications safely including:
- The Institute for Healthcare Improvement
- The Massachusetts Coalition for the Prevention of Medical Errors
- The Agency for Healthcare Research and Quality
Patients are encouraged to bring a list of all medications to any healthcare visit. If at all possible, patients should be encouraged to use the same pharmacy for all medications since the pharmacist can then review the list for any potential interactions and make interventions to prevent undesired outcomes.
Lastly, we also know older adults experience difficulty in taking their medications regularly due to difficulties in remembering to take doses, increasing costs associated with medications or the purchase of prescription drug coverage, and physical disabilities that complicate the process of removing the medication from the packaging, reading the directions, or performing the correct method of administration. There are several tools, guidelines, and other interventions that can be used to reduce the impact of these challenges on older adults.
Osterberg, L.M., Blaschke, T. (2005). Medication Adherence. NEJM, 353, 487-97
This review article details the definitions and epidemiology of medication adherence and non-adherence. It also describes various interventions to improve adherence.
Medication Cost Assistance
This is a US government sponsored website that can be used to access information about the Medicare prescription drug benefits (including online plan selection).
The following websites provide information about drug manufacturer patient assistance programs, state and company-sponsored programs, and other tips to help make medications more affordable:
- Needy Meds
- RX Assist
- Partnership for Prescription Assistance
- RX Hope
- Benefits CheckUp
- Access to Benefits Coalition
The American Society of Consultant Pharmacists
A professional organization that promotes ‘optimal medication management and improved health outcomes for all older persons.
American College of Clinical Pharmacy White Paper
This comprehensive, evidence based review covers important pharmacy practice and clinical issues related to medication use in the elderly. Topics include demographics, pharmacy practice issues, issues important to the pharmaceutical care of older patients, pharmacotherapy assessments, issues related to research in older adults, opportunities for training and specialization for pharmacists and advocacy.
Linnebur, S., O’Connell, M.B., Wessell, A., McCord, A., Kennedy, D., DeMaagd, G., et al. (2005). Pharmacy practice, Research, Education and Advocacy for Older Adults. Pharmacotherapy, 25(10), 1396-1430.