Geriatric Medication Safety: How to Protect Elderly Patients from Harmful Drugs
Nov, 21 2025
Geriatric Medication Safety Checker
Check if a medication is potentially inappropriate for older adults
This tool is based on the 2023 Beers Criteria. Enter a medication name to see if it's a potentially inappropriate medication (PIM) for patients 65+ and get safer alternatives.
Every year, over 1.3 million older adults in the U.S. end up in the hospital because of a bad reaction to their medications. Many of these reactions aren’t random. They’re predictable. They happen because doctors, pharmacists, and even families aren’t using the right tools to spot dangerous drug combinations in older patients. This isn’t just a problem - it’s a crisis in plain sight.
Why Older Adults Are at Higher Risk
Your body changes as you age. Your kidneys don’t filter drugs the same way. Your liver slows down. Your brain becomes more sensitive to sedatives. Even small doses of medications that are fine for a 40-year-old can cause confusion, falls, or kidney damage in someone over 65.And it’s not just one drug. Most older adults take five or more prescriptions. Some take ten or more. That’s called polypharmacy. It’s not always wrong - but it’s risky. When you stack drugs together, the chance of a bad interaction goes up fast. One study found that older adults taking three or more potentially inappropriate medications (PIMs) are 26% more likely to have a serious drug reaction than those taking none.
Common culprits? Benzodiazepines for sleep, NSAIDs like ibuprofen for arthritis pain, anticholinergics for overactive bladder, and even aspirin for heart protection in people over 70. These aren’t "bad" drugs. But in older bodies, they’re often more harmful than helpful.
The Beers Criteria: The Gold Standard for Safer Prescribing
In 1991, the American Geriatrics Society (AGS) created the Beers Criteria - a simple list of medications that should be avoided or used with extreme caution in people 65 and older. It’s not a rulebook. It’s a warning system.The latest version, updated in 2023, identifies 139 drugs or drug classes that pose higher risks. For example:
- Tramadol - now flagged because it can cause dangerous drops in sodium levels, especially when mixed with diuretics or antidepressants.
- Aspirin - no longer recommended for primary heart disease prevention in people 70+, because bleeding risk outweighs benefit.
- Indomethacin and ketorolac - NSAIDs that are off-limits for older adults due to kidney and stomach risks.
What makes the Beers Criteria powerful isn’t just the list - it’s how widely it’s used. Epic’s electronic health record system now flags these drugs in 87% of hospitals that treat older patients. That means when a doctor types in a prescription, the system says: "Wait. This patient is 78. This drug could hurt them."
The Missing Piece: What to Use Instead
Here’s the problem most doctors face: they know they should stop a drug - but they don’t know what to give instead.That’s why the AGS released the Beers Criteria Alternatives List in July 2025. For the first time, there’s a practical guide to safer options. It’s not just "stop the drug." It’s "here’s what works better."
For example:
- Instead of benzodiazepines for insomnia: try cognitive behavioral therapy for insomnia (CBT-I) - proven to work better long-term with no risk of falls.
- Instead of anticholinergics for overactive bladder: pelvic floor exercises or mirabegron, a safer bladder medication.
- Instead of NSAIDs for joint pain: acetaminophen, heat therapy, or weight loss - all backed by strong evidence.
Thirty-eight percent of the recommendations are non-drug options. That’s huge. It means we’re finally shifting from "more pills" to "better care."
How Emergency Rooms Are Fixing the Problem
Emergency departments (EDs) are ground zero for geriatric medication errors. Older patients come in with falls, confusion, or dizziness - often because of a drug reaction. And then they leave with the same dangerous meds they came in with.That’s changing. The Geriatric Emergency Medication Safety Recommendations (GEMS-Rx), released in March 2024, give ED teams a clear checklist for discharge. It focuses on eight high-risk drug classes: antipsychotics, benzodiazepines, anticholinergics, and others.
Hospitals using GEMS-Rx have seen a 29% drop in dangerous prescriptions at discharge. At the Mayo Clinic Rochester ED, a team of pharmacists, geriatricians, and ER doctors cut PIMs by 38% in just six months. How? They didn’t just rely on alerts. They had real people - trained pharmacists - reviewing every older patient’s meds before they left.
What Works - and What Doesn’t
Not all solutions are created equal.Computerized alerts in EHRs? Helpful, but only if they’re smart. A 2025 study found that when alerts fire for every older patient - even when the drug is clearly needed, like warfarin for atrial fibrillation - doctors start ignoring them. One ER doctor reported override rates of 65%. That’s alert fatigue. It’s dangerous.
What works better? Human-led teams. Programs that include clinical pharmacists and geriatricians cut PIM use by 37% - nearly twice as much as software alone. And when those teams also help patients taper off dangerous drugs, the drop in hospital readmissions jumps to 22%.
CMS is catching on. Starting in 2026, their Measure 238 will track not just dangerous drug combinations, but also whether doctors are actually stopping them. That’s a game-changer. Hospitals will be penalized not just for prescribing harm - but for failing to fix it.
Real Stories, Real Consequences
One 68-year-old man with high cholesterol and no history of bleeding was denied aspirin for heart protection because his doctor followed the new 70+ cutoff. He later had a heart attack. His family was furious. The rule was followed - but the person wasn’t considered.That’s the tension in geriatric care. Rules are meant to protect. But rigid rules can hurt. Dr. Joanne Schnur warned in JAMA Internal Medicine: "Beers Criteria without understanding patient goals can lead to inappropriate deprescribing." A frail 85-year-old with limited life expectancy might benefit from a sedative to sleep peacefully. A 72-year-old with strong bones and active hobbies might need a different approach.
It’s not about checking boxes. It’s about listening.
What Needs to Change
We have the tools. We have the data. We have the guidelines. But we’re still falling short.- Only 31% of rural EDs have full geriatric medication safety programs.
- There are only 1,247 pharmacists in the U.S. certified in geriatric pharmacy - not nearly enough for the 58 million older adults.
- Most doctors haven’t had proper training in deprescribing. A 2023 survey found 68% of primary care doctors didn’t know where to find safe alternatives.
The solution? Three things:
- Train every ED and clinic team - not just doctors, but nurses and pharmacists - in Beers Criteria and the Alternatives List.
- Embed clinical pharmacists into every geriatric care team. One FTE pharmacist per 20,000 ED visits is the minimum.
- Fix the alerts. EHRs need AI that understands context: "This patient has atrial fibrillation - warfarin is appropriate. Don’t flag it."
The cost of inaction is staggering. Medication-related problems cost the U.S. system over $528 billion a year. By 2030, they’ll make up 45% of all geriatric healthcare spending.
What You Can Do
If you’re caring for an older adult:- Ask: "Is this medication still needed?" Every six months.
- Ask: "Are there non-drug options?" Especially for sleep, pain, or bladder issues.
- Bring a complete list of all meds - including vitamins, supplements, and over-the-counter drugs - to every appointment.
- Ask for a pharmacist consult. Many hospitals offer free medication reviews.
If you’re a provider:
- Use the Beers Criteria and the Alternatives List - together.
- Don’t rely on EHR alerts alone. Talk to your patients.
- Start a deprescribing conversation: "We’ve been giving you this for years. Let’s see if it’s still helping."
Geriatric medication safety isn’t about limiting care. It’s about making care smarter. It’s about respecting the body’s changes. It’s about knowing when to stop - not just when to start.
What are potentially inappropriate medications (PIMs) for older adults?
Potentially inappropriate medications (PIMs) are drugs that carry more risk than benefit for adults 65 and older due to age-related changes in metabolism, kidney function, and brain sensitivity. Examples include benzodiazepines (like diazepam), NSAIDs (like indomethacin), anticholinergics (like oxybutynin), and certain opioids. The 2023 Beers Criteria® identifies 139 such medications or classes, with specific warnings based on health conditions, dosages, and drug interactions.
How does the Beers Criteria help reduce medication errors in seniors?
The Beers Criteria provide a clear, evidence-based list of medications to avoid or use with caution in older adults. When integrated into electronic health records, it triggers alerts when a provider tries to prescribe a high-risk drug. Studies show hospitals using the Beers Criteria with clinical pharmacist support reduce PIM use by up to 37%. It doesn’t stop prescribing - it makes it safer by prompting review and alternatives.
Why is deprescribing important for elderly patients?
Deprescribing means stopping medications that are no longer helpful or are causing harm. Many older adults take drugs they don’t need - sometimes for years. These can cause dizziness, confusion, falls, kidney damage, or even death. Deprescribing reduces hospitalizations, improves mental clarity, and increases mobility. A 2025 study showed multidisciplinary teams achieved a 42% deprescribing rate, with patients reporting better quality of life.
What are safe alternatives to common geriatric medications?
The 2025 AGS Alternatives List offers 47 evidence-based options. For insomnia, use cognitive behavioral therapy (CBT-I) instead of benzodiazepines. For overactive bladder, try pelvic floor exercises or mirabegron instead of anticholinergics. For joint pain, acetaminophen, heat therapy, or weight loss are safer than NSAIDs. For anxiety, non-drug approaches like mindfulness or structured routines often work better than sedatives.
How can families help prevent dangerous drug reactions in older relatives?
Families can be the first line of defense. Bring a complete list of all medications - including supplements and OTC drugs - to every doctor visit. Ask: "Is this still necessary?" "Can we try a non-drug option?" "What are the side effects?" Watch for signs like confusion, dizziness, or sudden falls. Don’t be afraid to ask for a pharmacist consult. Many hospitals offer free medication reviews. Small questions can prevent big problems.
What’s Next for Geriatric Medication Safety
In 2026, CMS will expand Measure 238 to track not just dangerous prescriptions, but also deprescribing events. That means hospitals will be rewarded for stopping harmful drugs - not just avoiding them.The AGS is also developing AI-driven standards for EHR alerts, aiming to cut alert fatigue by 50% by 2026. And the Geriatric ED Guidelines 2.0, due for full release in late 2025, will make medication safety a non-negotiable part of emergency care.
The future isn’t about more drugs. It’s about better decisions. And for older adults - who’ve spent decades taking care of everyone else - that’s not just good medicine. It’s long overdue.