Reviewed by the Help Dementia Editorial Team — our editors review every article for accuracy against guidance from the National Institute on Aging, the Alzheimer’s Association, and peer-reviewed sources.
Medication reviews after age 65 matter because older adults typically take multiple medications that can interact with each other, accumulate in the body differently than they did when younger, and sometimes become unnecessary as health circumstances change. A regular medication review—ideally conducted by a pharmacist or physician—can identify drugs that are causing more harm than benefit, catch dangerous drug interactions, adjust dosages for aging bodies, and ultimately reduce hospitalizations and side effects. For someone with early dementia or cognitive decline, this becomes even more critical: a medication interaction might look like confusion or memory loss, which can be mistakenly attributed to the dementia itself rather than to the drugs causing those symptoms. Consider a real scenario: Margaret, a 72-year-old, had been taking five medications prescribed by different specialists over the years. During a routine medication review, her pharmacist discovered that one blood pressure medication was being duplicated—two different doctors had prescribed similar drugs without knowing about each other.
Another medication was outdated for her current condition, and two others were interacting in a way that was contributing to her dizziness and falls. Once these issues were addressed through the review process, her balance improved, her energy returned, and her family noticed she seemed sharper. This kind of outcome is not unusual when comprehensive medication reviews take place. Medication management becomes increasingly complex after 65 because aging bodies handle drugs differently—the kidneys and liver work less efficiently, body composition changes, and the risk of side effects rises dramatically. Without regular reviews, medications can accumulate in the system, dosages that were appropriate at 55 may be too high at 75, and combinations that seemed safe in isolation can create unexpected problems when taken together.
Table of Contents
- What Changes in How Older Bodies Process Medications?
- How Drug Interactions and Side Effects Hide in Plain Sight
- The Special Risk of “Beers Criteria” Medications in Older Adults
- How to Prepare for and Get the Most from a Medication Review
- The Serious Risk of Sudden Medication Changes and How Reviews Guide Safe Adjustments
- How Medication Reviews Prevent Hospitalizations and Emergency Room Visits
- The Growing Role of Pharmacist-Led Reviews and Preventive Care
- Conclusion
- Frequently Asked Questions
What Changes in How Older Bodies Process Medications?
As the body ages, the organs responsible for processing medications work differently. The liver, which metabolizes most drugs, becomes less efficient, and the kidneys, which filter waste and drugs from the blood, lose function gradually starting around age 30 and accelerating after 65. This means medications stay in the body longer and can build up to higher levels than intended. Additionally, older adults typically have less water in their bodies and more body fat, which changes how drugs distribute and where they accumulate—a medication that dissolves in water might reach unexpectedly high concentrations in the bloodstream of an elderly person, while a fat-soluble drug might accumulate in fatty tissues over time. A comparison makes this clear: if a 45-year-old takes a standard dose of a blood pressure medication, their kidneys efficiently filter it out within the expected timeframe.
The same dose in an 80-year-old might linger in the body 20-30% longer because kidney function has declined. This isn’t just a minor difference—it can mean the difference between an effective dose and one that causes dizziness, fainting, or kidney problems. For people with cognitive concerns, falls from medication-induced dizziness or low blood pressure are particularly dangerous because they increase the risk of serious head injuries. Medication reviews account for these age-related changes by assessing whether dosages still fit the person’s current age and body composition. A reviewer will look at kidney and liver function tests, understand the person’s current health conditions, and consider how multiple drugs interact with these slower metabolic processes. This individualized approach is far more effective than following standard dosing guidelines that were developed for younger adults.
How Drug Interactions and Side Effects Hide in Plain Sight
One of the most dangerous aspects of taking multiple medications is that interactions often don’t announce themselves obviously. Instead, they create subtle symptoms that get misattributed to aging, disease progression, or even dementia. Confusion, memory problems, balance issues, constipation, or appetite loss might all be chalked up to normal aging or attributed to an underlying condition when they’re actually being caused by medications interacting with each other or by a medication that’s no longer appropriate. A warning here is important: not all side effects are obvious or immediate. Some drug interactions take weeks to develop, and some side effects are delayed or subtle.
For instance, certain blood pressure medications combined with diuretics can cause electrolyte imbalances that manifest as confusion and weakness. An older adult (or their family) might assume this is the beginning of dementia, but a medication review could identify and fix the actual culprit. The limitation, however, is that even thorough reviews can miss interactions if the reviewer doesn’t have a complete picture—if someone is taking over-the-counter medications, supplements, or drugs prescribed by multiple doctors who don’t communicate with each other, gaps in knowledge are likely. A medication review helps prevent this by looking at the complete medication picture and understanding how each drug might interact with the others, what side effects each can cause, and whether the side effects someone is experiencing might be drug-related rather than disease-related. This is particularly important for people already dealing with cognitive concerns, because cognitive symptoms from medications can sometimes be reversed if the offending drug is identified and stopped.
The Special Risk of “Beers Criteria” Medications in Older Adults
Geriatricians and pharmacists rely on something called the Beers Criteria—a list of medications known to be risky or potentially inappropriate for older adults. This list includes certain sedatives, some antihistamines, anticholinergic medications (which dry out the mouth and can impair cognition), some pain relievers, and certain blood pressure drugs. These medications aren’t necessarily “bad,” but they carry higher risks of serious side effects in older bodies and minds. For someone over 65, especially someone with cognitive concerns, exposure to these medications should be carefully justified and monitored. A specific example: many older adults take over-the-counter sleep aids containing diphenhydramine (Benadryl) or use prescription anticholinergic medications for various conditions.
These drugs work by blocking a neurotransmitter called acetylcholine, which plays a key role in memory and thinking. In older brains, this blocking effect can impair memory, increase confusion, and in some cases accelerate cognitive decline. A medication review specifically looks for these Beers Criteria medications and asks whether benefits truly outweigh risks or whether safer alternatives exist. For someone with early dementia, removing or reducing an anticholinergic medication can sometimes result in noticeable cognitive improvement. The goal of a medication review isn’t to eliminate all Beers Criteria medications—sometimes the benefits do justify the risks—but rather to ensure they’re being used only when necessary, at the lowest effective dose, and with full awareness of the potential cognitive and physical risks. This requires an intentional conversation between the older adult, their family, and their healthcare providers.
How to Prepare for and Get the Most from a Medication Review
A medication review typically involves meeting with a pharmacist or geriatrician who takes a detailed history of all medications, supplements, and over-the-counter drugs someone is taking, reviews the reasons each drug was prescribed, checks for interactions and side effects, and looks at recent lab results to assess kidney and liver function. The process works best when the person (or their family member, if the person has cognitive impairment) comes prepared with a complete list of every medication, including when it was started and why, as well as any side effects or changes in health noticed recently. Preparing for a review requires gathering information that many people don’t naturally keep organized. Bring all medication bottles to the appointment—not a list written from memory, but the actual bottles, which show exact dosages, refill dates, and manufacturers. Bring a list of any supplements, including vitamins, minerals, herbals, and even things like fish oil or probiotics.
Note any symptoms that developed or worsened after starting a new medication, any falls, confusion, appetite changes, or other changes that have happened in recent months. The comparison here is instructive: a person who brings a vague recollection of “I take something for my blood pressure” versus someone who brings the actual bottles and a timeline of changes will get a far more useful review. The tradeoff to understand is that a comprehensive medication review takes time—it’s not a five-minute conversation during a regular doctor’s visit. Many insurance plans, including Medicare, now cover comprehensive medication therapy management (MTM) services when someone is taking multiple chronic medications. This is worth asking about and taking advantage of because the investment of an hour or two can prevent serious problems down the line.
The Serious Risk of Sudden Medication Changes and How Reviews Guide Safe Adjustments
A critical warning: once a medication review identifies problematic medications, they should not be stopped abruptly without medical guidance. Some medications, particularly certain antidepressants, beta-blockers for heart disease, and benzodiazepines, can cause serious rebound effects if stopped suddenly. Blood pressure can spike, heart rate can become unstable, or anxiety and sleep problems can worsen dramatically. Safe medication changes require a plan for gradual dose reduction under medical supervision. The limitation many people face is that medication reviews identify problems but don’t automatically provide solutions.
Identifying that someone is on a medication that carries Beers Criteria risk is one thing; finding an alternative medication that works as well without the risks is sometimes difficult. A person might be taking an anticholinergic medication because earlier attempts with safer alternatives didn’t work. In these cases, the medication review conversation becomes about weighing real tradeoffs—is the cognitive risk worth the symptom relief, or is there another approach (physical therapy, non-medication treatment) worth trying first? The review process also protects against another common scenario: deprescribing (removing unnecessary medications) must be done intentionally and with monitoring. An older adult might improve significantly after a medication is stopped, or they might need a substitute, or they might need to switch gradually rather than stopping cold. A pharmacist or geriatrician reviewing medications can create a deprescribing plan that’s safe and monitors for any problems as medications are adjusted or eliminated.
How Medication Reviews Prevent Hospitalizations and Emergency Room Visits
Research consistently shows that medication-related problems are a leading cause of preventable hospitalizations in older adults. When someone ends up in the hospital because of a fall, severe confusion, dangerously low blood pressure, or other acute problems, medication interactions or inappropriate medications are often contributing factors. A well-timed medication review can prevent these crises before they happen. A specific example: James, 76, had been taking three different medications that each independently increase the risk of low blood pressure.
His doses were all within normal ranges, but taken together, they were dropping his blood pressure too low. He was having episodes of dizziness and near-fainting. During a medication review, the pharmacist identified this cumulative effect, and with his doctor’s guidance, one medication was switched to a safer alternative. His blood pressure stabilized, his dizziness resolved, and crucially, he didn’t have a fall and end up hospitalized with a head injury—a common scenario that can have serious consequences for older adults. The medication review saved him from a potentially life-altering event.
The Growing Role of Pharmacist-Led Reviews and Preventive Care
Medication management is increasingly recognized as a specialized field where pharmacists’ expertise can be just as valuable as physicians’ knowledge. Many healthcare systems now employ clinical pharmacists who specialize in medication therapy management, and some pharmacists work directly with older adults in community settings, conducting comprehensive reviews and making recommendations to physicians. This shift acknowledges that optimizing medications for aging bodies is a complex skill that deserves focused professional attention.
Looking forward, more older adults will have access to structured medication reviews as part of preventive healthcare. Some research suggests that regular, ongoing medication reviews (not just a one-time check) may be most beneficial, because as health changes, medications prescribed years ago might become outdated or inappropriate. For families and caregivers of people with cognitive concerns, advocating for a professional medication review should be a standard part of care planning, not something that happens only if problems emerge.
Conclusion
Medication reviews after age 65 matter because aging bodies process drugs differently, multiple medications create risks of dangerous interactions, and symptoms that look like dementia or normal aging might actually be medication side effects that can be reversed. A comprehensive review by a pharmacist or geriatrician can identify inappropriate medications, catch dangerous interactions, adjust dosages for aging bodies, and prevent hospitalizations. The process requires gathering complete information about all medications and supplements, finding a qualified reviewer, and being willing to have conversations about whether each medication still makes sense.
Taking the step to arrange a medication review—particularly for someone over 75, anyone taking five or more medications, or anyone with cognitive concerns—is one of the most practical and high-impact health decisions an older adult can make. It’s not something doctors typically recommend or initiate unless asked, so families and caregivers should advocate for this care. Ask about comprehensive medication therapy management services, bring all medication bottles to the appointment, and be prepared to discuss recent changes in health, cognition, or physical function. The investment of time in a thorough medication review often pays dividends in improved energy, sharper thinking, better balance, and fewer health crises.
Frequently Asked Questions
When should someone over 65 have their medications reviewed?
Ideally, anyone over 65 should have at least one comprehensive medication review. This is especially important if someone is taking five or more medications, has been on the same medications for several years without review, has experienced recent changes in cognition or physical function, or has had falls or other unexplained symptoms. Many older adults should have reviews every one to two years as medications and health circumstances change.
Who can conduct a medication review—my regular doctor or a pharmacist?
Both can, but they offer different perspectives. A pharmacist specializes in drug interactions, side effects, and dosing, and often has more time to conduct a thorough review. A geriatrician or internist experienced with older adults can address the medical side of whether a medication is still needed. Many insurance plans cover pharmacist-led medication therapy management (MTM) reviews. Ask your insurance whether this service is available and whether a referral is needed.
What if a medication review suggests stopping a medication I’ve been taking for years?
Any changes to medications should be made gradually and under medical supervision. Don’t stop medications on your own based on a review’s suggestion—work with your doctor or the pharmacist to create a safe plan for reducing or switching medications. Some medications cause serious problems if stopped suddenly, so the deprescribing process needs to be monitored carefully.
Can a medication review help if someone already has dementia?
Yes. In early-stage dementia, some cognitive symptoms might be made worse by medications. A review can identify and potentially adjust these drugs. In moderate or advanced dementia, medication reviews help prevent side effects and interactions that cause falls, confusion, or other complications. For people with dementia, family members usually participate in the medication review conversation.
Are there costs associated with a medication review?
Many insurance plans, including Medicare, cover comprehensive medication therapy management services, often at no cost to the patient. Coverage varies, so check with your insurance. Even if there’s a cost, the review often prevents expensive hospitalizations, emergency visits, and complications, making it a worthwhile investment.
What should I bring to a medication review appointment?
Bring all medication bottles (not a list from memory), all over-the-counter medications and supplements, a record of any symptoms or changes noticed in recent months, a list of all doctors you see, and your most recent lab results if you have them. Having complete, organized information makes the review much more thorough and useful.
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For more on this topic, see Alzheimer’s Association — medical tests.
