Let me ask you a straightforward question: are the medications you take every day actually helping you, or could they be hurting you? It’s a serious thought, and it’s one we need to talk about, especially as we get older. The way our bodies handle medicines changes dramatically over the years. A pill that was perfectly fine in your 40s might cause serious problems in your 60s or 70s. This isn’t about scaring you; it’s about empowering you with knowledge.
This is where something called the Beers Criteria comes in. And no, it has nothing to do with what kind of beer to pair with chicken wings or why some people drink it warm. The Beers Criteria is named after Dr. Mark Beers, a geriatrician who dedicated his life to studying how medications affect older adults. Back in 1991, he published a landmark list of medications that could be potentially inappropriate for seniors. Sadly, Dr. Beers passed away prematurely from dementia, but his work lives on and is updated every few years by the American Geriatrics Society. It has become an essential, evidence-based tool—free from the influence of Big Pharma—that helps doctors and patients make safer choices. It’s not a list of absolute “don’ts,” but rather a guide for having a thoughtful conversation about risks and benefits. It’s about moving from a one-size-fits-all approach to a personalized one, because your health is unique. (Based on the insights of Dr. Paul Zalzal and Dr. Brad Weening)
Key Takeaways
- What is the Beers Criteria? It’s a science-backed list of medications that may be unsuitable for older adults because their risks could outweigh their benefits.
- Why does it matter? As you age, your liver and kidneys may not break down drugs as efficiently, leading to a higher risk of side effects like falls, confusion, and organ damage.
- What are the main culprits? Five common medication classes on the list include certain sleep aids (Z-drugs), anticholinergics, acid reflux pills (PPIs), anti-inflammatories (NSAIDs), and anti-anxiety drugs (benzodiazepines).
- What should you do? Never stop taking a prescribed medication on your own. Use this information to start a conversation with your doctor and pharmacist to review your prescriptions regularly.
5 Common Medication Classes to Discuss With Your Doctor
We’re going to walk through five of the most common categories of drugs found on the Beers Criteria. We’ll count down from five to one, with number one being one of the most classic offenders. Remember, the goal here is to be informed, not alarmed.
5. Z-Drugs (Zopiclone, Zolpidem)
Ah, sleep. It’s the holy grail of health, but it can become incredibly elusive as we age. It’s no wonder that so-called “Z-drugs” (named because they help you get your Zs) are so popular. They definitely can help you fall asleep, but they come with a dark side for older individuals. The problem is that they can cause severe and prolonged drowsiness. You might take one to go to bed, but what happens when you need to get up in the middle of the night to use the restroom? Your balance is off, you’re groggy, and your risk of falling and breaking a hip skyrockets. These drugs can linger in your system longer than you think, leaving you sedated well into the next day. Before turning to these pills, it’s crucial to prioritize healthy sleep hygiene: a cold, dark, quiet room, no screens before bed, and avoiding stimulants like caffeine or alcohol in the evening. It’s not always easy, but it’s a much safer first step.
4. Anticholinergics (e.g., Benadryl, Oxybutynin)
This is a broad class of drugs that includes many common over-the-counter and prescription medications. You might take an antihistamine like Benadryl for an allergy or a rash, or a drug like oxybutynin for an overactive bladder. These drugs work by blocking a neurotransmitter called acetylcholine. While that might solve one problem, it can create others, especially for your brain. In older adults, anticholinergics can significantly interfere with cognition. They can make you drowsy, confused, dizzy, and even delirious. They are notorious for increasing the risk of falls. If you already have some mild memory challenges, these medications can make them much, much worse. It’s like putting a fog over your brain. Because they are so common and often available without a prescription, it’s vital to be aware of this risk and ask your doctor or pharmacist if a safer alternative exists.
3. Proton Pump Inhibitors (PPIs)
If you’ve ever had heartburn or acid reflux, you’ve probably heard of PPIs. Medications like omeprazole and pantoprazole are among the most widely prescribed drugs in the world. They work by dramatically reducing the amount of acid in your stomach. While this can provide relief, long-term use in older adults is a concern on the Beers Criteria for a few key reasons. The most significant issue is how they affect your bones. Stomach acid is essential for absorbing vital nutrients, including calcium. By suppressing acid, PPIs can impair your body’s ability to absorb calcium from both food and supplements. Over time, this can weaken your bones and increase your risk of fractures. Beyond bone health, PPIs have also been linked to confusion and other cognitive side effects in some older individuals. If you’re taking a PPI, it’s worth asking your doctor if you still need it or if you can use it at the lowest effective dose for the shortest possible time.
2. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
This category includes household names like ibuprofen (Advil, Motrin) and naproxen (Aleve), as well as prescription-strength versions. NSAIDs are fantastic at reducing pain, inflammation, and fever. However, their side effects can be severe in older adults, whose bodies are less resilient. The risks fall into three main areas. First, your kidneys: NSAIDs can impair kidney function, leading to fluid retention and high blood pressure, and in some cases, even kidney failure. Second, your stomach: These drugs are infamous for causing gastrointestinal ulcers and bleeding. It’s a common scenario to see someone taking NSAIDs for arthritis pain and then needing a PPI to manage the stomach side effects. Third, your cardiovascular system: The advice to take a daily baby aspirin for heart health has been reversed for most people who haven’t already had a heart attack or stroke. Studies found that for primary prevention, the risk of internal bleeding from the aspirin outweighed the heart benefits. The bottom line is that a drug you used freely in your 20s might not be safe for you anymore.
1. Benzodiazepines (e.g., Valium, Ativan)
Back in the ’60s, ’70s, and ’80s, benzodiazepines—often called “benzos”—were handed out like candy for anxiety and sleep. You might recognize names like Valium, Ativan, or any drug ending in “-pam.” In medical school, we were taught to be extremely cautious with these, and for good reason. For older adults, they are at the top of the list of medications to avoid. Why? They dramatically increase the risk of falls due to their sedative effects and impact on balance. They cause significant cognitive impairment, memory loss, and confusion. And because older bodies don’t break them down efficiently, they can lead to prolonged sedation, where you feel groggy and “out of it” for a long time. While they might be used in very specific, controlled situations at a low dose, they are not a reliable way to get restorative sleep and are generally considered unsafe for long-term use in the geriatric population.
How You Can Take Charge of Your Medication Safety
Knowing about the Beers Criteria is the first step. Now, here are five practical things you can do to protect yourself.
- Do NOT Stop Any Medication Suddenly. This is the most important rule. If you read this and realize you’re taking one of these medications, do not just stop. Abruptly stopping certain drugs can be dangerous. The first step is always to talk to the healthcare professional who prescribed it.
- Have an Open Conversation. Talk to your doctor. Ask them directly: “Why am I taking this? What are the benefits versus the risks for someone my age? Are there safer alternatives?” And don’t forget your pharmacist! They are medication experts. Before you buy any over-the-counter product, ask them if it’s safe with your age, health conditions, and other prescriptions. They would love to come down from their oddly elevated platforms to help you.
- Insist on an Annual Medication Review. Make it a point to sit down with your family doctor or nurse practitioner at least once a year specifically to review your full medication list. Ask the question for every single one: “Do I still need this?” Being thoughtful and intentional is key.
- Use One Pharmacy. Try to get all your prescriptions filled at a single pharmacy. This allows the pharmacist to have a complete record of everything you’re taking, making it much easier to spot potentially dangerous interactions between drugs prescribed by different doctors.
- Bring Your Meds to Every Appointment. Either bring a printed, up-to-date list of every single thing you take—prescriptions, over-the-counter drugs, vitamins, and herbal supplements—or, even better, just throw everything in a bag and bring it with you. This is the best way for your doctor to get a clear picture and apply the Beers Criteria to your specific situation.
Conclusion
The famous physician Sir William Osler once said, “The person who takes medicine must recover twice, once from the illness and once from the medicine.” The Beers Criteria is a powerful tool designed to help you avoid that second recovery. It’s not about fearing medication, as many drugs are life-saving. It’s about fostering respect for them and encouraging shared decision-making between you and your healthcare team. Check out the criteria online—the American Geriatrics Society has great resources. But most importantly, use this knowledge to start a conversation. Know what you’re taking, why you’re taking it, and what the risks are. Because when it comes to your well-being, you are in charge of your own health.
Source: Dr. Paul Zalzal and Dr. Brad Weening