Adults aged 65 and older with cognitive disorders face a significantly higher risk of adverse health outcomes, including emergency room visits and longer hospitalizations, when prescribed central nervous system medications, according to a study published August 4 in the Journal of the American Geriatrics Society. Researchers at the University at Buffalo found that nearly one-third of older Americans with conditions like dementia still take these potentially inappropriate drugs, though exposure rates declined from 39.3% in 2011 to 29.3% in 2022.
The Risks of Central Nervous System Medications in Older Adults
Older adults living with cognitive decline are particularly vulnerable to medications that target the central nervous system, such as treatments for anxiety, sleep disturbances, and psychosis. According to University at Buffalo researchers, inappropriate use of these drugs can lead to severe complications, including poorer mental health, increased hospitalizations, and a greater risk of 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,” said Haowen Hsu, PharmD, a postdoctoral fellow in the Department of Pharmacy Practice at the School of Pharmacy and Pharmaceutical Sciences and first author of the study.
Long-term use of central nervous system agents—such as benzodiazepines like Xanax for anxiety or sleep aids like Ambien—often impairs balance, coordination, and overall cognition in older patients.
Decline in Exposure and the Importance of Deprescribing
Examining data from 2,796 independently living older adults through the Medical Expenditure Panel Survey, researchers tracked exposure to inappropriate medications across an 11-year period. The study population represents approximately 29.7 million older Americans with cognitive disorders.
The findings showed a drop in inappropriate drug exposure from 39.3% in 2011 to 29.3% in 2022. While researchers did not investigate the specific drivers behind the decline, Hsu noted that increased attention from clinicians and researchers over the past two decades has gradually shifted geriatric care standards toward improved medication safety.
To mitigate these risks, health care providers utilize a strategy known as deprescribing. This process involves removing inappropriate medications, reducing frequencies or dosages, or switching patients to milder alternatives. Hsu emphasized that optimizing medication safety requires close collaboration between health care providers, community pharmacists, and homecare nurses.
Establishing Criteria for Medication Safety
The University at Buffalo research team based their evaluation on the American Geriatrics Society’s Beers Criteria, a comprehensive list of approximately 100 medications considered potentially harmful to older adults. Investigators narrowed their focus to patients diagnosed with cognitive disorders to isolate and analyze additional risks.
Despite the downward trend in inappropriate prescribing over the decade, researchers stress that continued vigilance is necessary. Approximately one-third of the target population remains exposed to these medications.
Broader institutional efforts at the University at Buffalo, including the interdisciplinary initiative Team Alice, examine the impacts of inappropriate prescriptions and drug interference on older adults. The initiative is named after Alice Brennan, who died in 2009 following complications from a prescribed muscle relaxant identified as inappropriate under the Beers Criteria.
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