Avoid benzodiazepines (any type) for treatment of insomnia, agitation, and delirium

All benzodiazepines increase the risk of falls, fracture, cognitive impairment, delirium, and motor vehicle crashes in older adults

Potentially inappropriate to use long-acting benzodiazepines (e.g., chlordiazepoxide [Librium], flurazepam, clorazepate) and benzodiazepines with long-acting metabolites (e.g., diazepam [Valium]) for longer than one month because of the risk of prolonged sedation, confusion, impaired balance, and falls

Also potentially inappropriate to use benzodiazepines in patients who fall, because the sedative may cause reduced sensorium and impair balance

Because of significantly increased risk of falls in older adults, benzodiazepines should be weaned and discontinued

Not listed

Potentially inappropriate to use calcium channel blockers in patients with chronic constipation, because they may exacerbate constipation

Decrease dosage or discontinue if the patient's blood pressure is adequately controlled with lisinopril and hydrochlorothiazide

Avoid aspirin dosage greater than 325 mg daily

May exacerbate existing ulcers or cause new or additional ulcers

Avoid use in patients with history of peptic ulcer disease unless other alternatives are not effective and patient can take gastroprotective agents (proton pump inhibitor or misoprostol [Cytotec])

Potentially inappropriate to use aspirin in certain circumstances, including in dosages greater than 150 mg daily; in patients with a history of peptic ulcer disease without a histamine H₂ antagonist or proton pump inhibitor; and in patients without a history of coronary, cerebral, or peripheral vascular symptoms or arterial occlusive event (not indicated)

Aspirin can be appropriate in patients with well-controlled hypertension and target organ damage, diabetes mellitus, or atrial fibrillation

Although aspirin meets the Beers and STOPP criteria for use in this patient, data are limited in persons 80 years and older. The potential benefit due to a reduction in myocardial infarction and ischemic stroke should be balanced with the risk of gastrointestinal or intracranial bleeding and falls

Herbal medications not addressed

Herbal medications not addressed

Consider discontinuing because it decreases serum glucose levels and increases risk of hypoglycemia

Herbal medications not addressed

Herbal medications not addressed

Consider discontinuing because it interacts with aspirin and can increase risk of bleeding

Long-duration sulfonylureas should be avoided

Glyburide has a higher risk of severe prolonged hypoglycemia in older adults

Not listed

Consider discontinuing because of the high risk of hypoglycemia

Diuretics not listed

Potentially inappropriate to use thiazide diuretics in patients with a history of gout, because they may exacerbate gout

Lower dose often effective

Monitor potassium levels and renal function

Use in patients with syncope should be avoided to prevent increasing the risk of orthostatic hypotension or bradycardia

Potentially inappropriate to use angiotensin-converting enzyme inhibitors when optimization of monotherapy within a single drug class has not been observed before considering a new class of drug

Consider decreasing dosage because the patient's creatinine clearance is 32 mL per minute per 1.73 m² (0.53 mL per second per m²) based on the Cockcroft-Gault equation*

Dose range of 2.5 to 10 mg daily often used in older adults

Not listed

Not listed

Decrease dosage to 500 mg twice daily because of the patient's age and history of heart failure

Although the patient's serum creatinine level is less than 1.4 mg per dL (123.76 μmol per L), creatinine clearance is 32 mL per minute per 1.73 m², which will increase the risk of acidosis

Not listed

Not listed

Consider stopping because indication may no longer exist

Consider obtaining a free phenytoin level because hypoalbuminemia is common in older adults and phenytoin is highly protein bound

Statins not listed

Not listed

Consider decreasing or discontinuing because of uncertain benefit in older adults and association with memory loss^A3

The U.S. Food and Drug Administration recommends maximum dosage of 40 mg daily in adults

Avoid Lowers seizure threshold

Not listed

Decrease dosage or discontinue because of the effects of age and alcoholism on liver function

Tramadol also causes constipation in older adults prone to constipation and small bowel obstructions

Avoid long-term use (more than 90 days) because of adverse central nervous system effects

Adverse effects include delirium, falls, and fractures

Minimal improvement in sleep latency and duration

Not listed

Decrease dosage or discontinue because of increased risk of dependency in older adults