Geriatric Medication Safety: Reducing Elderly Drug Risks with Evidence-Based Guidelines

geriatric medication safety isn't just a buzzword-it's the practice of ensuring older adults get the right drugs at the right doses without dangerous side effects. Every day, 3,000 seniors in the U.S. end up in the hospital because of medication problems. That's not a statistic-it's a crisis affecting real people and healthcare systems. With seniors taking an average of 4-5 medications daily, the risks pile up fast. But there's hope. Tools like the Beers Criteriaa set of guidelines developed by the American Geriatrics Society to identify medications that may be inappropriate for older adults and the AGS Alternatives Lista resource providing evidence-based non-pharmacologic and pharmacologic alternatives to unsafe medications are changing how we handle meds for seniors.

What Makes Medication Safety Critical for Seniors?

Older adults face unique challenges. Their bodies process drugs differently due to age-related changes in liver and kidney function. This means standard doses can become too strong or linger too long. The polypharmacytaking multiple medications simultaneously problem makes things worse. Seniors on four or more medications are 91% more likely to experience adverse drug events (ADEs), according to JAMA Network Open (2025). ADEs aren't just uncomfortable-they can mean falls, confusion, kidney failure, or even death. For example, combining a diuretic with tramadol can cause dangerous sodium imbalances, leading to hospitalization. This isn't rare. One in three hospital admissions for adults 65+ relates to medication problems, as reported by the American Pharmacists Association in 2024.

The Beers Criteria: A Lifesaving Tool

First published in 1991, the Beers Criteriaa set of guidelines developed by the American Geriatrics Society to identify medications that may be inappropriate for older adults has evolved into the gold standard for geriatric medication safety. The 2023 update lists 139 medications or classes that pose risks. For instance, the opioid meperidine is flagged because it can cause confusion and seizures in seniors. Common NSAIDs like indomethacin and ketorolac are also on the list due to stomach bleeding and kidney damage risks. Tramadol was added in 2023 because of its link to hyponatremia and SIADH, especially when taken with diuretics or antidepressants. Doctors now must monitor sodium levels closely when prescribing it. Even aspirin for primary heart disease prevention is now cautioned for those over 70, as bleeding risks outweigh benefits for many. These updates are based on real-world data. A 2025 JAMA Network Open review found that seniors taking just one potentially inappropriate medication (PIM) from the Beers list had a 26% higher chance of an ADE.

AGS Alternatives List: Solving the "What Now?" Problem

When doctors identify a risky medication, they often struggle to find safe replacements. That's where the AGS Alternatives Lista resource providing evidence-based non-pharmacologic and pharmacologic alternatives to unsafe medications comes in. Released in July 2025, this companion resource offers 47 evidence-based alternatives across 12 medication categories. For anxiety, it suggests non-drug options like cognitive behavioral therapy or relaxation techniques instead of benzodiazepines. For pain management, it recommends physical therapy or acetaminophen over NSAIDs. A 2023 survey of 1,200 primary care physicians found 68% struggled to find safe alternatives when deprescribing PIMs. The Alternatives List directly addresses this gap. It's not just theory-Mayo Clinic pharmacists used it to reduce benzodiazepine prescriptions by 32% in six months, without worsening patient outcomes.

CMS Measure 238: Holding Hospitals Accountable

The Centers for Medicare & Medicaid Services (CMS) Measure 238 tracks how often older patients get two high-risk medications from the same class. This includes benzodiazepines, anticholinergics, and NSAIDs. Why? Taking two drugs from the same class doubles the risk of falls, confusion, and kidney damage. For example, prescribing both a long-acting and short-acting benzodiazepine for insomnia increases fall risk by 50%. Hospitals now must report this data, pushing them to improve medication management. A 2025 study in JAMA Network Open showed that hospitals using CMS Measure 238 data reduced high-risk medication combinations by 28% in one year. But it's not just about counting doses-it's about understanding why. A patient on warfarin for atrial fibrillation isn't at risk, but a senior on two different NSAIDs for arthritis pain is. This precision matters.

Real-World Challenges: Alert Fatigue and System Gaps

Implementing these guidelines isn't always smooth. A 2025 Medscape survey of 850 emergency physicians found 41% faced alert fatigue from EHR systems. For example, Epic's Beers Criteria alerts might fire for every patient over 65, even when a medication is appropriate-like warfarin for atrial fibrillation. This leads to doctors overriding alerts 65% of the time. Dr. Lisa Chen from ACEP Geriatric ED shared on Facebook: "The alerts fire for every patient over 65, even when clinically appropriate-leading to override rates of 65%." Rural hospitals face even bigger hurdles. Only 31% of rural EDs have full geriatric medication safety programs, according to the NRHA 2025 Access Report. Without specialized staff, they struggle to interpret complex guidelines. A 2024 survey by the American Hospital Association found 63% of hospitals cited EHR integration complexities as a major barrier. Solutions include customizing alert thresholds and giving pharmacists override authority.

Success Stories: How Teams Are Winning

Despite challenges, hospitals are making progress. Mayo Clinic Rochester's emergency department reduced potentially inappropriate medications (PIMs) by 38% in six months by adding clinical pharmacists to their team. They spent 12 weeks retraining staff and redesigning workflows. Similarly, the University of Alabama at Birmingham cut 30-day readmissions by 22% through pharmacist-led medication reconciliation. These programs share a common thread: multidisciplinary teamwork. A 2025 JAMA Network Open meta-analysis found that ED-based programs with clinical pharmacists and geriatricians achieved a 37.2% reduction in PIMs-compared to 22.1% with standalone computerized alerts. At the Mayo Clinic, pharmacists now review all senior patients' medications before discharge, catching issues like duplicate prescriptions or dangerous combinations. This hands-on approach works because it's personalized. They don't just follow rules-they ask, "Is this drug really needed for this patient?"

Practical Steps for Healthcare Providers

How can your team start improving geriatric medication safety? First, build a multidisciplinary team. Include clinical pharmacists and geriatricians-studies show this reduces PIMs by 37.2%. Second, customize EHR alerts to avoid unnecessary warnings. For example, set thresholds so alerts only trigger for high-risk combinations like two benzodiazepines, not for appropriate medications like warfarin. Third, use the GEDC Toolkit's "Deprescribing Conversation Scripts" to talk to patients about stopping unnecessary meds. These scripts help explain why a drug might be risky and what safer alternatives exist. Finally, track progress with CMS Measure 238 data. Knowing your hospital's numbers keeps everyone focused. The American Pharmacists Association recommends allocating 0.5 full-time equivalent clinical pharmacists per 20,000 annual ED visits. This investment pays off: hospitals with dedicated pharmacists see 34.7% fewer ADEs compared to 18.3% without pharmacist involvement.

What's Next for Geriatric Medication Safety?

CMS plans to expand Measure 238 in 2026 to include monitoring deprescribing events. Ten new medications, including gabapentinoids and proton pump inhibitors, will join the high-risk list. The AGS is also developing "Beers Criteria Digital Integration Standards" for 2026 to reduce alert fatigue through AI-driven clinical context awareness. With the senior population growing to 74 million by 2030, these changes are critical. Without intervention, medication-related problems could cost $528.4 billion annually by 2030. The most promising solution? Integrated care models that follow seniors from emergency rooms to primary care. Johns Hopkins' 2025 roadmap prioritizes "seamless medication management" across care settings. This means pharmacists coordinating with doctors during hospital discharge and primary care visits. Real-world examples show this works: a pilot program in Michigan cut ADE-related readmissions by 29% by having pharmacists follow up with seniors within 48 hours of discharge.