As we get older, medications that once worked smoothly can start to behave differently in the body. After age 65, natural changes in kidney function, liver metabolism, body composition, and brain sensitivity can all affect how drugs are absorbed, processed, and eliminated. This does not mean medications are unsafe or unnecessary. It does mean that they often need closer monitoring, dose adjustments, and periodic review. Many medication-related problems in older adults are preventable, especially when patients, caregivers, physicians, and pharmacists work together.
Below are some of the most common medication risks that increase with age—and what to watch for.
Even healthy aging changes how the body handles medicine. Kidney function gradually declines over time, which can cause certain drugs to stay in the system longer than intended. The liver, which metabolizes many medications, may process drugs more slowly. In addition, older adults tend to have less total body water and more body fat, which can change how medications distribute in the body and how long they remain active.
The brain also becomes more sensitive to medications that affect alertness, sleep, mood, and balance. A dose that felt mild at 50 can feel much stronger at 70. For this reason, healthcare providers often follow the principle of “start low and go slow” when prescribing for older adults.
Many adults over 65 take five or more prescription medications, sometimes prescribed by different specialists who may not always communicate directly with one another. This situation, known as polypharmacy, increases the risk of drug interactions and side effects. Each additional medication does not simply add risk in a straight line; it increases complexity. A drug may interact with another medication, worsen an existing condition, or create new symptoms that are mistaken for aging itself.
Sometimes a medication causes a side effect that leads to another prescription to treat that side effect. This is called a “prescribing cascade.” Over time, the medication list grows longer, and the original issue may no longer be clear. Regular medication reviews can help identify when a drug is no longer necessary or when a safer alternative might exist.
Falls are one of the most serious health risks for older adults, and certain medications can contribute to dizziness, slowed reaction time, or sudden drops in blood pressure when standing. Medications used for sleep, anxiety, pain, blood pressure, or bladder control can all affect balance.
For example, drugs that cause sedation or muscle relaxation may make nighttime bathroom trips more dangerous. Blood pressure medications can sometimes cause lightheadedness when standing up quickly. Even some over-the-counter sleep aids and allergy medications can increase fall risk. If you notice new dizziness, unsteadiness, or increased falls, your medication list should be reviewed promptly.
Some medications can affect memory, focus, or mental clarity, particularly in older adults. Drugs with “anticholinergic” effects—found in certain sleep aids, cold medications, bladder medications, and antidepressants—can interfere with brain chemicals involved in memory and thinking. While these effects may be mild in younger adults, they can be more pronounced after 65.
Symptoms might include confusion, forgetfulness, agitation, or unusual drowsiness. Families sometimes worry that these changes signal dementia, when in fact they may be medication-related. Reviewing prescriptions and over-the-counter products can sometimes significantly improve mental clarity.
As people age, the body becomes more sensitive to medications that thin the blood. Drugs used to prevent strokes, heart attacks, or blood clots are often essential and life-saving, but they must be carefully balanced. Combining certain pain relievers, such as NSAIDs, with blood thinners can increase the risk of stomach bleeding. Even some antidepressants may raise bleeding risk when taken with aspirin or anticoagulants.
Unusual bruising, black stools, prolonged bleeding from cuts, or unexplained weakness should be reported promptly. Regular monitoring and clear communication with healthcare providers help keep these medications safe.
For older adults with diabetes, certain medications can increase the risk of low blood sugar, also known as hypoglycemia. Symptoms may include shakiness, confusion, sweating, weakness, or even fainting. In seniors, hypoglycemia can sometimes appear primarily as confusion or unusual behavior rather than classic symptoms.
Severe low blood sugar can lead to falls, injuries, or hospitalization. In many cases, blood sugar targets are adjusted as patients age to reduce this risk. If you or a loved one has experienced episodes of low blood sugar, a medication review may help identify safer options.
Some medications can affect the body’s fluid balance. Diuretics (“water pills”), certain blood pressure medications, and even some laxatives can lead to dehydration or changes in sodium and potassium levels. Older adults are generally more sensitive to these shifts, especially during hot weather or illness.
Symptoms of dehydration or electrolyte imbalance may include weakness, confusion, headaches, or irregular heartbeat. Staying well hydrated and having periodic lab tests can reduce these risks.
Medication safety after 65 is not about stopping everything. It is about making sure each medication is still necessary, appropriately dosed, and not interacting with anything else. National guidelines such as those from the American Geriatrics Society help clinicians identify medications that may carry higher risk in older adults, but individualized review is always essential.
You should consider scheduling a medication review if you have recently been hospitalized, started a new prescription, experienced new side effects, had a fall, or simply have not reviewed your medications in the past year. Bringing a complete list—including vitamins and over-the-counter products—can make the review much more effective.
Growing older does not mean medications will inevitably cause problems. It means that monitoring becomes more important. Small adjustments—such as lowering a dose, changing timing, or removing a medication that is no longer needed—can significantly improve energy, clarity, balance, and overall quality of life.
If you are over 65 and taking multiple medications, consider asking your pharmacist for a comprehensive medication checkup. A careful review today can help prevent complications tomorrow and ensure that every medication you take is truly working for you, not against you.
