WHEN LESS MEDICINE IS BETTER
Many adults over 50 take several prescription medicines every day. Some are important and even lifesaving. But sometimes medications that once helped can begin to cause more harm than good as we age. This is where the idea of “deprescribing” comes in.
Deprescribing means carefully reducing or stopping medicines that may no longer be needed or may be unsafe. It does not mean stopping medicines suddenly or ignoring your doctor’s advice. Instead, it is a thoughtful process between a patient and healthcare provider to make sure every medicine still has a clear benefit.
As we get older, our bodies change. The liver and kidneys may not process medications as quickly. Medicines can stay in the body longer and cause stronger side effects. Older adults are also more sensitive to medications that affect the brain, balance, and blood pressure. This is why medication safety becomes so important after age 65.
One of the most widely used tools to help doctors identify risky medications in older adults is called the Beers Criteria. The Beers Criteria is a list of medications that may be potentially inappropriate or dangerous for older adults because of their side effects and risks.
One major concern with many medications on the Beers list is that they increase the risk of falls, confusion, memory problems, and hospitalizations. Falls are especially dangerous in older adults and can lead to broken hips, loss of independence, and even death.
Some of the most common high-risk medications are sleeping pills and sedatives. Drugs such as zolpidem, commonly known as Ambien, can increase the risk of confusion, nighttime falls, and next-day drowsiness. Many people think these medications are harmless because they help them sleep, but studies show they may create more problems over time.
Another group of medications that can be risky are benzodiazepines. These include medicines like Xanax, Ativan, and Valium. These drugs are often prescribed for anxiety or insomnia. In older adults they can cause dizziness, slowed thinking, memory trouble, and increased fall risk. They may also become habit-forming and difficult to stop.
Certain antihistamines are also on the Beers list. A common example is Benadryl. Many adults use it as a sleep aid because it causes drowsiness. But in older adults it can lead to confusion, constipation, dry mouth, urinary retention, and daytime sleepiness. In some people it may even worsen memory problems.
Some over-the-counter nighttime cold medicines also contain these sedating antihistamines. Many people do not realize they are taking medications that may not be safe for them.
Pain medications can also be a problem. Opioids such as OxyContin or Vicodin may increase the risk of sedation, falls, and breathing problems, especially when combined with sleeping pills or anxiety medications.
Even certain medications for blood pressure, diabetes, or bladder control can sometimes contribute to dizziness, fainting, or confusion if doses are too high or if they are no longer needed.
This does not mean these medications are always wrong. Sometimes they are appropriate and necessary. The key is regular review. Older adults should periodically ask their doctor or pharmacist several important questions:
- Do I still need this medication?
- Is this medication helping me?
- Could this medication increase my risk of falling or confusion?
- Are there safer alternatives?
- Can the dose be lowered?
- Are any medications interacting with each other?
Many older adults are surprised to learn that symptoms they blamed on aging may actually be medication side effects. Fatigue, poor balance, forgetfulness, dizziness, and even trouble sleeping may sometimes improve after adjusting medications.
Sleep is one area where deprescribing can make a big difference. Many adults become dependent on sleeping pills over time. Unfortunately, these medications often do not produce natural, restorative sleep. They may sedate the brain without improving true sleep quality.
The good news is that healthy sleep habits can often improve sleep naturally without relying on risky medications.
A few safer sleep strategies include:
- Keeping a regular bedtime and wake time
- Getting morning sunlight exposure
- Avoiding caffeine late in the day
- Limiting alcohol before bedtime
- Exercising regularly
- Keeping the bedroom cool and dark
- Avoiding screens before bed
- Using relaxation techniques like deep breathing or reading
Exercise may be one of the most powerful tools for improving sleep naturally. Regular physical activity helps regulate the body’s internal clock and reduces stress and anxiety.
For adults who want a deeper step-by-step plan for improving sleep naturally, my book, The Complete Guide to Better Sleep After 50, covers sleep habits, exercise, stress management, sleep apnea, medications, and practical ways to improve sleep without overrelying on sedatives.
Deprescribing should always be done carefully. Some medications need to be reduced slowly to avoid withdrawal symptoms or rebound insomnia. Never stop a prescription medication abruptly without discussing it with your healthcare provider.
The goal is not to take away medicines that help. The goal is to make sure every medication still makes sense and improves quality of life.
As we age, sometimes the safest prescription is fewer prescriptions.