Long-term care medication risks that deserve a second look

When an older adult moves into long-term care, families often hope the medication system will be simpler and safer. In practice, it can become more complicated. AARP’s latest caregiving article says the drugs most worth watching are not just prescription medicines, but also common over-the-counter products that can add to confusion, sedation, falls, and other side effects. That concern fits with broader guidance from the National Institute on Aging, the CDC, and medication-safety research showing that polypharmacy is common in long-term care and can raise the risk of adverse drug events. https://www.aarp.org/caregiving/medical/medications-long-term-care/

For adults 45 and older, the issue matters in two directions: you may be helping a parent, spouse, or other relative navigate care now, and you may also be thinking ahead about your own aging. Medication reviews are one of the few practical tools that can uncover unnecessary duplication, outdated prescriptions, or side effects that are easy to miss when many clinicians are involved. AARP notes that caregivers should ask whether each medicine is still needed, whether any drugs overlap, and whether new behavior or mobility changes could be medication-related. https://www.aarp.org/caregiving/medical/medications-long-term-care/

What the AARP article is warning caregivers about

AARP’s report focuses on seven medication categories that deserve special attention in long-term care, including antipsychotics, benzodiazepines, opioids, sleep medicines, blood thinners, and certain over-the-counter products with anticholinergic effects. The article’s central point is not that these medicines are always inappropriate; it is that they deserve periodic reassessment because the balance between benefit and harm can change as health conditions change. https://www.aarp.org/caregiving/medical/medications-long-term-care/

The story also emphasizes that a medication list can look “correct” on paper while still creating problems in real life. A resident might receive several medicines from different prescribers, or take an over-the-counter product that is not obvious to the care team. FDA educational materials for older adults make a similar point: medication reconciliation is often where hidden risks are found, especially when families and facilities do not have a complete picture of everything being taken. https://www.aarp.org/caregiving/medical/medications-long-term-care/

Why this matters more after 45

As people age, they are more likely to live with multiple chronic conditions and take several medications at once. That combination does not automatically mean the treatment plan is wrong, but it does increase complexity. The National Institute on Aging says inappropriate polypharmacy can raise the risk of adverse drug effects, including falls, cognitive impairment, and harmful interactions between drugs or between a drug and a disease. https://www.nia.nih.gov/news/dangers-polypharmacy-and-case-deprescribing-older-adults?mod=article_inline

This is especially relevant in long-term care, where residents commonly have multimorbidity and polypharmacy. A recent systematic review of long-term care medication-quality indicators found that these settings are specifically challenged by medication-related harm, and a PubMed review on high-risk medication use in long-term care highlights the same underlying pattern: many residents take multiple drugs, which increases the need for ongoing review. https://pmc.ncbi.nlm.nih.gov/articles/PMC12569564/

Falls are one of the clearest concerns for families to keep in mind. AARP cites research linking use of four or more prescription medicines per day with a higher likelihood of recurrent falls in older adults. Other long-term care studies have also found that polypharmacy, opioid use, and anticholinergic medication use predict falls. Observational studies like these cannot prove that a given medicine caused a fall, but they do support close monitoring when medication lists grow longer. https://www.aarp.org/caregiving/medical/medications-long-term-care/

What the evidence actually shows

Some of the strongest evidence is about risk patterns, not guaranteed outcomes. For example, antipsychotics can be important for certain psychiatric conditions, but in older adults they can also cause sedation and reduced alertness. The AARP article says caregivers should pay attention if a loved one becomes unusually sleepy, less engaged, or less steady after a new antipsychotic or a dose increase. That advice aligns with the broader geriatric literature showing that high-risk medications are a major driver of preventable adverse events in older adults. https://www.aarp.org/caregiving/medical/medications-long-term-care/

Over-the-counter antihistamines with anticholinergic effects are another example. AARP specifically points to diphenhydramine-containing products, including combination sleep aids and pain relievers, because families may not realize they are adding a sedating ingredient. AARP’s pharmacists note that the overall anticholinergic burden matters, since these medications can contribute to confusion, constipation, urinary retention, blurred vision, and falls. That concern is supported by NIA and CDC materials describing medication-related fall risk in older adults. https://www.aarp.org/caregiving/medical/medications-long-term-care/

Blood thinners also deserve extra care, but for a different reason: the goal is usually not to avoid them outright. Instead, the issue is whether the medicine is still indicated, whether dosing is appropriate, and whether bleeding risk has changed because of other medicines, kidney function, or recent health events. AARP includes them on the watch list because they can be very helpful, yet they also require careful follow-up. https://www.aarp.org/caregiving/medical/medications-long-term-care/

What remains uncertain

Not every medication problem in long-term care is caused by the drug itself. A sudden change in behavior, balance, appetite, or alertness can also reflect infection, dehydration, pain, poor sleep, depression, or progression of an underlying condition. That is why the best approach is usually to consider medication as one possible explanation, not the only one. The evidence base for many medication-safety interventions is strongest for identifying risk, not for proving that one specific review method prevents every bad outcome in every resident. https://www.aarp.org/caregiving/medical/medications-long-term-care/

There is also no one-size-fits-all list that applies to every older adult. A medicine that is risky for one person may be appropriate for another, especially when a symptom is severe or when the drug is preventing a major complication. That is why clinicians often use medication review frameworks rather than a simple yes-or-no rule. The key question is whether each medicine still has a clear purpose and an acceptable tradeoff. https://www.aarp.org/caregiving/medical/medications-long-term-care/

What caregivers can discuss with the care team

AARP recommends asking for a full medication review with a health care professional, including a check for duplicate therapies, side effects, and drugs that may no longer be necessary. The article also points out that long-term care facilities are required to conduct monthly medication reviews, and that Medicare’s annual wellness visit is another chance to discuss the full list of prescriptions, over-the-counter medicines, and supplements. https://www.aarp.org/caregiving/medical/medications-long-term-care/

For caregivers of adults 45 and older, a useful conversation starter is simple: “What is this medicine for, what side effects should we watch for, and is it still the best option?” It can also help to ask whether a consultant pharmacist should review the regimen, especially when a loved one has multiple specialists or recent health changes. FDA and CDC materials support this kind of reconciliation process because it can uncover hidden overlaps, dosing problems, and medicines that contribute to falls. https://www.aarp.org/caregiving/medical/medications-long-term-care/

If a resident develops sudden confusion, new unsteadiness, extreme drowsiness, fainting, or signs of bleeding after a medication change, that warrants prompt medical attention rather than waiting for the next routine review. Those symptoms are not specific to one drug class, but they can signal a serious medication problem or another urgent issue. https://www.aarp.org/caregiving/medical/medications-long-term-care/

For families thinking ahead, the broader message is straightforward: medication safety in long-term care depends on ongoing review, not a one-time admission checklist. The more medicines a person takes, the more important it becomes to keep the list current, question duplicates, and watch for changes in function or alertness that may be easy to mistake for “just aging.” https://www.aarp.org/caregiving/medical/medications-long-term-care/