By:DengYue International Business Division

Introduction: Medication Safety in Older Adults — The Invisible Guardian of Healthy Aging

As global population aging continues to accelerate, the number of individuals aged 65 and older in Mainland China and Hong Kong continues to rise. Many older adults live with multiple chronic conditions, including hypertension, diabetes, coronary artery disease, chronic obstructive pulmonary disease (COPD), and osteoarthritis, making long-term use of multiple medications increasingly common.

However, age-related declines in liver and kidney function, reduced drug metabolism, and the growing prevalence of polypharmacy place older adults at significantly higher risk for adverse drug reactions (ADRs).

Studies have shown that Potentially Inappropriate Medications (PIMs) can increase the risk of falls, fractures, delirium, bleeding events, cognitive impairment, recurrent hospitalizations, and even mortality. Therefore, establishing a scientific medication management system for older adults has become a major focus of geriatric medicine worldwide.

The latest American Geriatrics Society (AGS) Beers Criteria® 2023 is widely recognized as one of the most important international tools for improving medication safety in older adults. Meanwhile, China has introduced localized guidelines such as the Criteria for Potentially Inappropriate Medication Use in Older Adults (2024 Edition), providing more tailored recommendations for Asian populations.

As a company specializing in innovative therapies for chronic diseases and international pharmaceutical supply chain services, DengYueMed Hong Kong has long focused on the medication needs of elderly patients with chronic conditions. The company advocates evidence-based medication practices and supports healthcare professionals and patients in optimizing geriatric medication management.

What Are the Beers Criteria? A Trusted Tool for Improving Medication Safety in Older Adults

The AGS Beers Criteria® was originally developed by geriatrician Dr. Mark Beers in 1991 and has become one of the most widely used tools worldwide for identifying potentially inappropriate medications in older adults.

Its primary objectives include:

● Identifying high-risk medications

● Reducing adverse drug reactions

● Optimizing prescribing practices in older adults

● Improving clinical outcomes and quality of life

● Reducing healthcare utilization associated with medication-related problems

Key Components of the 2023 Beers Criteria

1. Medications Generally to Avoid in Older Adults

Examples include:

● Strong anticholinergic medications

● Benzodiazepines

● Certain sedative-hypnotics

● Selected pain medications

2. Disease-Specific Medication Recommendations

Special considerations are provided for patients with:

● Dementia

● Parkinson’s disease

● Heart failure

● High fall risk

and other specific conditions.

3. Medications to Use with Caution

These medications are not necessarily contraindicated but require careful monitoring and individualized assessment.

4. Clinically Important Drug–Drug Interactions

The criteria identify combinations associated with increased risks of:

● Bleeding

● Hypoglycemia

● Kidney injury

● Central nervous system depression

5. Medication Use Based on Renal Function

Dose adjustments or avoidance recommendations are provided based on:

● Estimated Glomerular Filtration Rate (eGFR)

● Creatinine Clearance (CrCl)

Localized Application in China

Because of differences in ethnicity, disease patterns, prescribing practices, and medication availability, Chinese experts have developed guidance documents such as the Criteria for Potentially Inappropriate Medication Use in Older Adults (2024 Edition).

In clinical practice, experts generally recommend combining:

Beers Criteria + Chinese Criteria + Individualized Clinical Assessment

to support more appropriate medication decisions for elderly Chinese patients.

Common Potentially Inappropriate Medications in Older Adults (Key Interpretations of the Beers Criteria)

The following examples are based on the AGS Beers Criteria® 2023 and are intended for educational purposes only.

1. Central Nervous System (CNS) Medications

Benzodiazepines

Examples:

● Diazepam

● Lorazepam

● Alprazolam

Potential risks:

● Falls

● Fractures

● Memory impairment

● Delirium

● Increased risk of motor vehicle accidents

Older adults are particularly sensitive to sedative effects, making these agents generally unsuitable for long-term treatment of insomnia.

Non-Benzodiazepine Hypnotics

Examples:

● Zolpidem

● Eszopiclone

Although commonly referred to as “Z-drugs,” they carry risks of falls and cognitive impairment comparable to benzodiazepines.

Anticholinergic Medications

Examples:

● Diphenhydramine

● Promethazine

● Cyclobenzaprine

Potential adverse effects include:

● Dry mouth

● Constipation

● Urinary retention

● Blurred vision

● Cognitive decline

Long-term cumulative anticholinergic burden has also been associated with an increased risk of dementia.

2. Cardiovascular and Antithrombotic Medications

Aspirin for Primary Prevention

In very elderly individuals, particularly those aged 80 years and older, the risk of bleeding may outweigh the cardiovascular benefits.

Decisions regarding continued use should be based on individualized risk assessment by a healthcare professional.

Rivaroxaban

The 2023 Beers Criteria highlights that some older adults may face a higher risk of major bleeding compared with alternative anticoagulation strategies.

Factors requiring careful evaluation include:

● Renal function

● History of bleeding

● Concomitant medications

Alpha-Adrenergic Blockers

Examples:

● Doxazosin

● Terazosin

Potential risks include:

● Dizziness

● Orthostatic hypotension

● Falls

Therefore, these agents are generally not recommended as first-line therapy for hypertension in older adults.

3. Pain Management and Anti-Inflammatory Medications

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Examples:

● Ibuprofen

● Diclofenac

● Indomethacin

Long-term use may increase the risk of:

● Gastrointestinal bleeding

● Peptic ulcers

● Cardiovascular events

● Kidney dysfunction

Opioid Analgesics

Examples:

● Oxycodone

● Morphine

● Fentanyl

Potential risks include:

● Constipation

● Excessive sedation

● Respiratory depression

● Falls

The risks increase significantly when combined with sedative medications.

4. Endocrine and Metabolic Medications

Long-Acting Sulfonylureas

Example:

● Glyburide

These agents may cause severe and prolonged hypoglycemia.

Many current clinical guidelines recommend safer alternatives whenever possible.

SGLT-2 Inhibitors

Examples:

● Dapagliflozin

● Empagliflozin

These medications provide proven cardiovascular and renal benefits.

However, older adults should still be monitored for:

● Urinary tract infections

● Genital infections

● Dehydration

● Hypotension

5. Other Medication Classes

Proton Pump Inhibitors (PPIs)

Examples:

● Omeprazole

● Esomeprazole

Long-term use has been associated with:

● Fractures

● Clostridioides difficile infection

● Hypomagnesemia

Antipsychotic Medications

Unless there is a clear clinical indication, long-term use for behavioral symptom management should generally be avoided.

Potential risks include:

● Stroke

● Cognitive decline

● Increased mortality

High-Risk Factors and Risk Assessment for Medication Use in Older Adults

In addition to medication-related risks, several patient-related factors deserve attention.

Physiological Changes

Aging is associated with:

● Reduced glomerular filtration rate

● Decreased hepatic metabolism

● Increased body fat percentage

● Reduced total body water

These changes can significantly affect drug distribution, metabolism, and elimination.

Polypharmacy

Research indicates that:

● The risk of drug interactions increases substantially when five or more medications are used simultaneously.

● The risk rises exponentially when ten or more medications are prescribed.

High-Risk Populations

These include:

● Female patients

● Adults aged 75 years and older

● Individuals with cognitive impairment

● Residents of long-term care facilities

● Frequently hospitalized patients

Practical Strategies for Safer Medication Use: Translating the Beers Criteria into Clinical Practice

1. Provide a Complete Medication History

This should include:

● Prescription medications

● Over-the-counter (OTC) drugs

● Traditional Chinese medicines

● Dietary supplements

● Herbal products

to minimize the risk of overlooked interactions.

2. Conduct Regular Medication Reviews

A comprehensive medication review is recommended every 3–6 months.

For medications with limited ongoing benefit, deprescribing may be considered under professional supervision.

3. Prioritize Safer Alternatives

Examples include:

● Non-pharmacological sleep interventions

● Cognitive behavioral therapy

● Physical rehabilitation programs

These approaches can help reduce medication dependence.

4. Strengthen Clinical Monitoring

Key parameters include:

● eGFR

● Blood glucose

● INR

● Electrolytes

● Blood pressure

Regular monitoring can help identify emerging risks early.

5. Educate Patients and Caregivers

Immediate medical attention should be sought if symptoms such as:

● Dizziness

● Altered mental status

● Black stools

● Unexplained falls

occur.

6. Obtain Medications Through Legitimate and Reliable Sources

For older adults requiring long-term management of chronic diseases, medication quality and supply chain integrity are equally important.

DengYueMed Hong Kong specializes in the global supply of innovative medicines, chronic disease therapies, and specialty pharmaceuticals. Through strict procurement standards and quality management systems, the company provides healthcare institutions and patients with transparent, traceable pharmaceutical information and supports safer long-term medication management.

Conclusion: Promoting Safe Medication Use for Healthy Aging

As societies continue to age, medication safety in older adults has become an increasingly important healthcare priority.

The Beers Criteria provides valuable guidance for identifying potentially inappropriate medications, but all prescribing decisions should ultimately be based on individualized clinical assessment.

For older adults, regularly reviewing medications, minimizing unnecessary drug use, monitoring drug interactions, and obtaining medications through legitimate channels are essential strategies for reducing medication-related risks.

DengYueMed remains committed to monitoring global advances in geriatric medicine and chronic disease management. Through professional pharmaceutical supply chain services and evidence-based medical information support, the company aims to help healthcare providers, pharmacists, patients, and caregivers build a safer, more standardized, and sustainable medication management environment for older adults.