As the population ages, medication safety is becoming increasingly important for people with cognitive decline.
Older adults with dementia and other cognitive disorders are less likely than they were a decade ago to receive medications that can worsen memory, balance, and coordination. But nearly one in three still takes at least one potentially inappropriate drug.
University at Buffalo researchers analyzed data from 2,796 independently living adults age 65 and older with cognitive disorders. Exposure to potentially harmful medications fell from 39.3% in 2011 to 29.3% in 2022, according to a study published in the Journal of the American Geriatrics Society.
Why These Drugs Can Be Risky
The medications include drugs used for anxiety, insomnia, psychosis, and other conditions involving the central nervous system. In older adults with cognitive disorders, they can increase the risk of emergency department visits, hospitalization, poorer mental health, and premature death.
“This is a population with some mental issues that relate to the central nervous system. These drugs also act on the central nervous system, so they can be too much for older adults if inappropriately used,” says Haowen Hsu, PharmD, the study’s first author.
Benzodiazepines such as Xanax and sleep medications such as Ambien can impair cognition, balance, and coordination, particularly in older adults.
Deprescribing Could Reduce Harm
One strategy is deprescribing, which can involve stopping a medication, lowering its dose, reducing how often it is taken, or replacing it with a safer alternative.
“A central word for patients in this age group is ‘deprescribing,’ which means, for example, removing inappropriate medications and decreasing the frequency or the dosage. In some cases, it means replacing the current medication with a milder alternative,” Hsu says.
The researchers used the American Geriatrics Society’s Beers Criteria, a list of medications that may be risky for older adults. Their analysis represented approximately 29.7 million older Americans with cognitive disorders from 2011 to 2022.
Progress, but Continued Exposure
The study did not examine why prescribing declined. Hsu said increased attention to geriatric medication safety may have contributed.
“We were happy to see the percentages of harm decline over that 11-year period,” he says. “However, one-third of our target population is still exposed to these harmful medications, which isn’t good.”
The researchers say regular medication reviews and tools such as the Drug Burden Index could help identify patients carrying a high cumulative burden from sedative or anticholinergic drugs.
Further studies are needed to determine whether better medication management can reduce hospitalizations and emergency visits while improving quality of life in older adults with cognitive disorders.
Reference: “Cognitive Potentially Inappropriate Medications, Quality of Life, and Healthcare Use in Older Adults With Cognitive Disorders” by Haowen Hsu, Collin M. Clark, Steven Feuerstein, Robert G. Wahler, Ranjit Singh and David M. Jacobs, 4 August 2026, Journal of the American Geriatrics Society.
DOI: 10.1111/jgs.70607
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