Medications used to treat other diseases can impair cognitive function in patients with dementia

We are talking about medications for anxiety, sleep problems, psychoses, and other conditions — in particular, benzodiazepines (for example, Xanax) and sleeping pills (such as Ambien). In older people, such medications can disrupt balance and coordination, weaken memory and thinking. The consequences can be serious: more emergency room visits, more frequent and longer hospitalizations, deterioration of mental health, and an increased risk of premature death.

To assess the risks, the scientists relied on the Beers Criteria, a list of about 100 drugs potentially dangerous for the elderly. Then they narrowed the focus and separately studied the risks specifically for people with diagnosed cognitive impairments. The study participants are a representative sample reflecting the situation of approximately 29.7 million older Americans with cognitive problems between 2011 and 2022.

The good news is that the proportion of elderly people receiving potentially harmful medications has decreased noticeably: from 39.3 % in 2011 to 29.3 % in 2022. This is likely due to the fact that over the past two decades, doctors and researchers have begun to pay more attention to the safety of medications for the elderly, and the focus on the judicious prescription of therapy has increased in geriatric care. However, even with this decline, the situation remains alarming, as almost one in three patients at risk still receives medications that could harm them.

The key solution here is “deprescribing” — a term that specialists actively use. It does not simply mean discontinuing a medication, but rather implementing a well‑thought‑out strategy: reducing the dose, decreasing the frequency of administration, switching to a milder medication, or completely discontinuing the drug if its benefits do not outweigh the risks. For example, a person who has been taking a benzodiazepine for anxiety for years may need to gradually reduce the dose as they age; otherwise, the drug will start to have a stronger impact on coordination and memory.

The history of this issue at the University at Buffalo is closely linked to the Team Alice initiative, named in memory of Alice Brennan, who died in 2009 due to complications after being prescribed a medication deemed unsafe for the elderly according to the Beers criteria. The tragedy revealed systemic gaps and prompted researchers to work on changes that would help protect other patients. Currently, Team Alice is focused on developing approaches to improve the safety of drug therapy and to train specialists.

The demographic situation adds particular urgency to the problem, as for the first time in history, the number of people aged 65 and over worldwide has exceeded the number of children under five. At the same time, nearly three‑quarters of older people live with two or more chronic diseases, which means they take multiple medications, and the risk of adverse drug interactions and side effects becomes even higher.

Most older patients are regularly seen by doctors, which means that dangerous prescriptions can be identified and adjusted together with the care team. Further research is needed to understand how strategies for the rational use of medications can improve quality of life, reduce hospitalizations, and ease the burden on the healthcare system.