The Beers Criteria is an American Geriatrics Society list of potentially inappropriate medicines that adults 65 and older should generally avoid or use with caution, described in the 2023 update. For older adults with dementia, it singles out anticholinergics, antipsychotics, benzodiazepines and Z-drug sleep medicines because they worsen thinking, delirium and behavior. Think of the list as a review tool, not a stop order. It helps families and clinicians spot risky prescriptions and discuss safer drug and nondrug options.
Medical information disclaimer: This article is for general educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a physician or other qualified health professional about symptoms, medications, tests, or treatment decisions.
Table of Contents
- Why dementia raises the risk
- Which medicines should you question?
- What should you ask at the visit?
- What safer review looks like
Why dementia raises the risk
A brain with dementia has less reserve to handle sedation, confusion and chemical side effects. Drugs that mildly dull a healthy older adult can trigger frank delirium, falls or a sharp loss of memory in a person with dementia. That added sensitivity is why the criteria give dementia its own caution group.
The concern is not only short-term grogginess. Repeated or combined exposure can prolong confusion, worsen behavioral symptoms and lead to injury. A medication review looks at dose, duration, duplicates and total burden, not one pill alone.
Which medicines should you question?
Strongly anticholinergic drugs block a brain chemical needed for attention and memory. Common examples include first-generation antihistamines such as diphenhydramine, often sold for allergies, colds or sleep. They can cause confusion and memory loss, with cumulative use linked to delirium, falls and dementia. Antipsychotics carry a stricter warning for behavioral problems of dementia or delirium.
The National Library of Medicine paper on the 2023 criteria states they should be avoided unless nondrug measures failed and the patient threatens harm, citing higher stroke, faster cognitive decline and mortality, in the full Beers 2023 paper. MedlinePlus warns that older adults with dementia treated with quetiapine face increased risk of death and of stroke or ministroke, and that quetiapine is not FDA-approved for dementia behavior problems, in its quetiapine drug information. Benzodiazepines for anxiety or agitation and Z-drugs for insomnia belong on the same question list. They increase sensitivity, cognitive impairment, delirium, falls, fractures and crashes in older adults. Ask about any sleep aid, nerve pill or calming pill, including over-the-counter products and as-needed doses.
What should you ask at the visit?
Do not stop a flagged drug suddenly, since withdrawal and rebound symptoms can be dangerous. Use the appointment to clarify why each drug was started, what it helps now and what happens if the dose is lowered. Bring every prescription, over-the-counter product, vitamin and supplement in the original bottles.
- Which drug treats which symptom, and is that symptom still present?
- Could a non-drug step reduce the need for sedation, such as pain control, daytime light and activity, or a calmer bedtime routine?
- What taper, monitoring and follow-up plan will catch withdrawal, return of symptoms or improved alertness?
- Who coordinates changes among the primary doctor, neurologist, psychiatrist and pharmacist?
What safer review looks like
A good review often finds a drug that helped briefly but stayed on too long. The clinician may lower the dose, shorten use for sleep or anxiety, replace a strongly anticholinergic allergy drug, or test stopping one drug at a time. Families can help by tracking sleep, agitation, falls, alertness and bathroom or appetite changes for one to two weeks after any change.
The criteria apply to adults 65 and older except hospice or end-of-life care, so they guide rather than mandate stopping. The American Geriatrics Society issued a July 2025 alternatives list of safer drug and nondrug options to support review and deprescribing, described in its alternatives list announcement. Ask the pharmacist to run the current list against that safer-options approach before the next refill.
