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.
Laurie Sala
November 22, 2025 AT 16:29This is terrifying... I didn't realize my mom's nightly Ambien and ibuprofen were basically a time bomb... Why isn't this taught in med school???
Lisa Detanna
November 24, 2025 AT 08:33I love how this article doesn't just list problems but gives real alternatives. CBT-I for sleep? That's what my grandma tried after her fall-and she hasn't had another since. Non-drug solutions are underrated.
Also, props to the pharmacists who actually talk to patients. They're the real heroes here.
Demi-Louise Brown
November 25, 2025 AT 15:21The integration of clinical pharmacists into geriatric care teams is not merely beneficial-it is essential. The data demonstrates a clear correlation between multidisciplinary intervention and reduced hospital readmissions. Without structural investment in human expertise, technological alerts alone remain insufficient.
Furthermore, the 2026 CMS Measure 238 represents a necessary shift from punitive to incentivized outcomes.
Matthew Mahar
November 27, 2025 AT 06:13OMG this is the most important thing i’ve read all year. My dad got prescribed tramadol after his knee surgery and then he was zombified for 3 months. We didn’t know it was the med. He’s fine now but why did no one warn us??
Also I think the beers criteria should be on every pharmacy receipt. Like a little warning sticker. ‘DANGER: THIS DRUG MAY MAKE GRANDPA SLEEP FOREVER’
John Mackaill
November 28, 2025 AT 00:57As someone who’s worked in UK primary care for 20 years, I’ve seen this play out endlessly. The Beers Criteria are gold-but they’re useless if GPs are rushed, under-resourced, and never trained in deprescribing.
We need mandatory geriatric pharmacology modules in medical school. Not as an elective. As a core requirement.
Richard Wöhrl
November 29, 2025 AT 14:11Just had my 74-year-old mother’s meds reviewed by a clinical pharmacist last week-she was on five PIMs. Four were stopped. One replaced with a non-drug approach. She’s sleeping better, walking without a cane, and not confused anymore.
And yes, the EHR alerts? They’re terrible. I’ve seen them flag warfarin for a patient with atrial fibrillation and a CHA2DS2-VASc score of 5. It’s like the system thinks we’re idiots.
But when a real person-trained, focused, not rushed-looks at the whole picture? That’s when change happens. The 37% reduction in PIMs? That’s not magic. That’s teamwork.
Kane Ren
December 1, 2025 AT 13:40My grandma took 11 pills a day. We thought she was just old. Turns out she was being poisoned. We cut it down to three. Now she laughs, bakes cookies, and remembers my birthday. This isn’t just medicine. It’s dignity.
And no-I don’t care if the doctor says it’s ‘standard.’ If it makes someone dizzy, it’s not standard. It’s negligence.
Charmaine Barcelon
December 2, 2025 AT 19:07Why do we even let old people take pills? They’re just going to mess up anyway. My aunt took a sleeping pill and fell down the stairs. Now she’s in a wheelchair. Should’ve just let her sleep on the floor.
And why do we care so much about seniors? They’re not contributing anymore. Let them die peacefully instead of wasting money on ‘alternatives’ like yoga and heat packs.
Karla Morales
December 4, 2025 AT 08:10⚠️ WARNING: This article is dangerously optimistic. The Beers Criteria are not a panacea. They’re a bureaucratic tool that ignores individual variability. The 2025 Alternatives List? A marketing ploy by AGS to sell more training modules. Real clinical judgment? Still missing.
Also, why is everyone ignoring the fact that 70% of elderly patients are on meds prescribed by specialists who never see them again? 🤔
And no-CBT-I doesn’t work for dementia patients. Don’t pretend it does. 🙄
Javier Rain
December 5, 2025 AT 11:49YES. This is the kind of content we need more of. I’m a nurse in a rural clinic-we don’t have a pharmacist on staff. We’re doing our best with what we’ve got. But this article? It’s giving us a roadmap.
Also, I’ve started asking patients: ‘What’s one thing you want to stop taking?’ It’s wild how many say, ‘That sleepy pill.’ We’re not trying to take away comfort-we’re trying to give back clarity.
Let’s train the whole team. Not just the docs. The aides, the receptionists, the volunteers. Everyone needs to know this stuff.
Bryson Carroll
December 5, 2025 AT 21:46Let’s be real-this is just liberal guilt dressed up as medicine. Old people are expensive. Their bodies are broken. Stop pretending we can fix them with yoga and hand-holding. The real solution? Stop wasting billions on ‘alternatives’ and let natural selection take its course. The Beers Criteria are just a way to make doctors feel better about not trying harder.
Also, who funded this study? AGS? Of course they did. They sell the training. It’s a money machine.
Lisa Lee
December 7, 2025 AT 20:54Why are Americans so obsessed with medicating everything? In Canada, we just tell seniors to tough it out. Less pills, less hospitals, less waste. Your system is broken because you think every problem needs a drug. My grandfather lived to 92 on nothing but tea and silence. You don’t need a PhD to know that.
Jennifer Shannon
December 8, 2025 AT 10:19There’s something deeply human here, you know? Not just the drugs, not just the algorithms, not even the Beers Criteria-it’s the quiet moment when a doctor looks at an 82-year-old woman and says, ‘You’ve been on this for 15 years. What do you think?’
That’s the magic. Not the checklist. Not the AI. Not the CMS measure. It’s the permission to ask. To listen. To say, ‘Maybe we got this wrong.’
I’ve watched my mother go from foggy, falling, and afraid to bright-eyed, walking the dog, and asking about my job. All because someone finally asked: ‘Is this still helping?’
It’s not about being young or old. It’s about being seen. And that? That’s the real alternative.
Suzan Wanjiru
December 8, 2025 AT 11:50Just want to say that the AGS Alternatives List is a game changer. My clinic started using it last month. We’ve already cut 14 PIMs in our geriatric panel. Patients are happier. Falls are down. And the best part? No one got mad when we took away their meds. They were tired of being tired.
Also-get your family to bring a list of ALL meds to every appointment. Including turmeric, CBD, and that 'natural' sleep aid from the gas station. Those count too.
Kezia Katherine Lewis
December 9, 2025 AT 02:13From a geriatric pharmacy specialist: The 2023 Beers Criteria update reflects a paradigm shift from risk-avoidance to risk-stratification. The inclusion of context-sensitive flags-e.g., renal function, frailty index, life expectancy-is critical for clinical decision-making. However, implementation remains fragmented due to EHR interoperability failures and lack of standardized deprescribing protocols across care settings.
Moreover, the 2025 Alternatives List is the first evidence-based framework to operationalize deprescribing as a therapeutic intervention rather than a de-escalation. This is not merely guideline evolution-it is clinical innovation.