5. Certain Bladder-Control Medicines

Some medications used to treat overactive bladder work by blocking acetylcholine.

Examples include:

Oxybutynin
Tolterodine
Solifenacin
Certain other antimuscarinic medicines

These medications can be useful for people with urinary urgency and overactive bladder, but some have anticholinergic effects that can affect cognition.

This becomes particularly important when an older person is taking multiple medications with anticholinergic properties.

The problem may not be obvious if each individual medicine is considered separately.

A person might take:

One bladder medication + one sleep medicine + one older allergy medicine

without realizing that several medications are contributing to the same anticholinergic burden.

The 2023 Beers Criteria specifically highlights the cumulative effects of medications with strong anticholinergic properties in older adults.

If someone taking bladder medication develops new confusion, unusual sleepiness or memory problems, a medication review is worth discussing.

6. Certain Antipsychotic Medicines

Antipsychotic medications are powerful medicines used for conditions such as schizophrenia and certain other psychiatric disorders.

They can also sometimes be prescribed in older adults with severe behavioral symptoms.

However, their use in people with dementia requires particular caution.

The 2023 Beers Criteria recommends avoiding antipsychotics for behavioral symptoms of dementia except in specific circumstances, such as when FDA-approved indications exist or when symptoms pose a significant risk and other approaches have failed.

Antipsychotics can cause:

Sedation
Movement problems
Orthostatic hypotension
Cognitive effects
Increased risk of falls

They also carry an important safety warning concerning increased mortality in older adults with dementia.

That does not mean antipsychotics “cause dementia.”

Rather, they can be dangerous in certain older adults, particularly when used unnecessarily or for long periods without reassessment.

For this reason, clinicians generally try to use the lowest effective dose for the shortest appropriate period when these medications are necessary.

7. Opioid Pain Medicines

Opioid medications are powerful pain-relieving drugs.

Examples include:

Morphine
Oxycodone
Hydrocodone
Fentanyl
Tramadol
Codeine

They can cause:

Drowsiness
Dizziness
Confusion
Reduced alertness
Constipation
Breathing problems

These effects can be particularly concerning in older adults.

Opioids don’t simply “destroy the brain,” and they can be medically necessary for severe pain.

But prolonged or inappropriate use can create significant risks.

The 2023 Beers Criteria considers opioids among medications requiring particular caution in older adults, especially in combination with other sedating medicines. (AGs Journals)

For example, combining an opioid with a benzodiazepine can increase sedation and other risks.

This is why doctors and pharmacists need to consider the entire medication list, not just individual drugs.

8. Sedative Sleep Medicines

Sleep medications can also affect memory and mental alertness.

This includes certain prescription sedatives and other medications that cause significant sedation.

Some people begin taking a sleep medication because they have difficulty falling asleep, but over time they may notice:

Morning grogginess
Poor concentration
Memory difficulties
Balance problems
Daytime sleepiness

Older adults are particularly vulnerable to falls and confusion from sedating medications.

The Beers Criteria includes several sedative-hypnotic medication groups among medicines that should generally be avoided or used cautiously in older adults depending on the circumstances.

This doesn’t mean someone with insomnia should simply stop their medication.

Instead, it may be worth discussing whether the medication is still necessary and whether non-drug approaches could help.