Recently, one of my elderly patients came into my office to follow up on care for her hypertension and diabetes. She told me she was taking her medication as directed, but when I looked up her chart I saw that she was often getting her medication refilled one or two months late. This patient was already on the maximum doses of three medications to control blood pressure, yet her blood pressure was not on target. Instead of adding a fourth medication, we instead discussed ways to make sure she got each dose as prescribed.

Prescribing and taking medication is a serious matter, and medication use presents different concerns and challenges, particularly for patients 65 and older. In the case of my patient, memory loss was a factor, but there are other special considerations for older patients. Some that are common include:

•   Chronic diseases: these are more common in older patients.

•   Aging bodies and changing metabolism: this shifts how the body reacts to medication and may mean a different medication or a different dose is needed. Sometimes, a drug is no longer safe and the prescriber will decide to wean the patient off the medication.

•   Older people are also more likely to be taking multiple prescription medications as well as over-the-counter drugs and supplements, which should be evaluated and monitored for interactions.

The best way to ensure medication safety is to become knowledgeable about medications and use all available resources, including your doctor, to make sure you are taking the safest medications, in the safest manner possible. Knowing the following three terms can also help.

The Beers list

Formally titled the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, this detailed list of potentially inappropriate medications for older adults was first published in 1991 by a panel of experts led by geriatrician Dr. Mark Beers. In 2011, the American Geriatric Society assumed the responsibility of updating and maintaining the Beers criteria. The most recent update was in 2015 (the URL is in Resources, below.) It lists:

•      Detailed information on potentially inappropriate medications for use in older adults,

•      Medications to avoid in specific diseases such as heart failure, Parkinson’s disease, and dementia.

•      Medications to be used with caution in older adults

•      Select serious drug interactions documented to be associated with harm in older adults

•      Drugs that should be avoided or dose-adjusted based on the individual’s kidney function

The criteria are applicable to all older adults with the exclusion of those in palliative and hospice care. Using this list can lead to safer prescribing by your doctor, and you may bring it to your medical provider to check that you have the correct medications for your age and condition. A companion paper offers recommendations for alternative treatment options when a medication cannot be used.

Examples of drugs listed on the Beers list include those that lead to cognitive impairment in older adults and/or lead to the risk of falls. These Include drugs that cause sedation, such as certain allergy medications, sleeping medications, antipsychotics, anti-nausea medications and some antidepressants.


Sometimes, “less is more” when it comes to prescribing medications for older patients.

Polypharmacy is defined as the use of five or more prescription medications that are taken routinely. It’s a situation common for older adults, particularly those in nursing homes. However, there is rising concern that older adults are taking too many medications: 50 percent of older adults take one or more medications that are not medically necessary, and those medications can cause symptoms that may lead to even more medications. Patients may also take over-the-counter medications and dietary supplements, leading to further interactions. It is very important for your physician to know all the medications you are taking. Most computerized pharmacy lists will now notify the physician of an interaction when the medication is entered in the medical record.

Medication adherence

Even if you and your health provider have agreed on a medication, it’s critical that you take it as prescribed. Medication adherence means that the patient takes medication exactly as the prescriber has directed. Medications for chronic diseases, for instance, are given not just to control symptoms, but also to prevent serious life-threatening complications that can lead to hospitalization and sometimes death. Don’t take a different dose, or skip a dose, even if you feel better and think the medication is no longer needed.


•   20-30 percent of new prescriptions are never filled at the pharmacy.

•   Medication is not taken as prescribed 50 percent of the time.

•   After six months of taking medications for chronic conditions, many patients will start to take less medication than they were prescribed or will stop the medication altogether.

•   Only 51 percent of patients taking medications for high blood pressure continue taking their medication during their long-term treatment.

Be honest with your physician if you have concerns about taking a medication as prescribed, so you can work together developing a care plan that you know you can follow. There are many barriers to poor adherence, including dosing frequency, drug costs, side effects, poor understanding of the reasons for a medication in a treatment plan and memory issues that interfere with ordering or remembering to take a medication. Whatever the reason, your medical team is there to help you develop a treatment plan that works for you with a full understanding of your resources, condition, and lifestyle.

When I saw that my patient had delayed refills, for instance, she and I discussed her situation and determined that her son might help her better manage her medications so she was not missing doses. Fiercely independent, she was hesitant to accept help, but she preferred this plan to taking a fourth medication for her blood pressure. Her son would buy her a two-week medication dispenser and fill it, checking regularly to make sure she was following the plan, and tracking her refills.

Medication prescribing has become increasingly complicated, but we also have more resources to help guide our prescribing. Using those resources, and discussing all medications and supplements regularly with your doctor, is the best way to protect yourself.


Beers Criteria:

Ginny Sugimoto, MD, is a board-certified family practice doctor at Kaiser Permanente Port Orchard Medical Center. Her philosophy of care includes emphasizing a preventive lifestyle and shared decision-making in partnership with her patients.


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