Medicines that can affect mood and memory after 65

When an older person becomes more forgetful, foggy, unsteady or down, people often blame age or early dementia. Sometimes the real cause is sitting in the medicine cabinet. A pill that was fine at 50 can act differently at 75, and some combinations add up to trouble.

This guide explains which common medicines are most likely to affect thinking, mood and balance in later life, what the AGS Beers Criteria are, and how to ask for a safe medicine review. It goes deeper on the later-life angle of our page Medicines that can affect mood and memory.

Signs a medicine may be part of the problem

Talk with your doctor or pharmacist if you or a loved one notices:

• New confusion, forgetfulness or trouble finding words
• Feeling drowsy, foggy or "hung over" in the morning
• Dizziness, unsteadiness, or a recent fall
• New low mood, loss of interest, or anxiety
• Sudden confusion that comes and goes, with poor attention, especially during an illness or hospital stay (this can be delirium, see below)
• Constipation, dry mouth, blurry vision or trouble passing urine, which are common signs of anticholinergic medicines³

Pay special attention to changes that started after a new medicine, a dose change, or adding an over-the-counter product. Certain medicines can sometimes cause symptoms of depression.⁷

Why older bodies react differently

As we age, the liver and kidneys clear many drugs more slowly, so medicines stay in the body longer.¹ Taking many medicines raises the chance of side effects and harmful interactions, including drug-disease interactions, where a medicine for one condition makes another one worse.²

Medicines most often linked to memory, mood and falls

These groups appear on the AGS lists of medicines older adults should avoid or use with caution:³

Studies of sedative-hypnotic sleeping pills link them to about five times the risk of memory problems and about twice the risk of falls, fractures and car crashes in older adults.¹ They are also habit-forming, and the body can come to depend on them.^1,8

Anticholinergic medicines and dementia risk

Anticholinergic medicines block a brain chemical involved in memory. A large English study compared about 59,000 people with dementia with 225,000 people without. People with the highest long-term use of strong anticholinergic medicines had about 1.5 times the odds of dementia. The link was clearest for certain antidepressants, bladder medicines, Parkinson's medicines, seizure medicines and antipsychotics.⁹ This study shows a link, not proof that the medicines cause dementia. But it is one more reason to review these medicines.

What the Beers Criteria are and are not

The American Geriatrics Society Beers Criteria are lists of medicines that may be risky for adults 65 and older. The 2023 update reviewed more than 1,500 studies.⁴ There are five lists: medicines to avoid for most older adults, to avoid with certain conditions, to use with caution, risky combinations, and those to adjust or avoid with poor kidney function.⁴

The AGS stresses that the criteria are guidance, not a mandate. They should not be the only basis for a decision, and a listed medicine may still be the right choice for you.^4,5 They do not apply to hospice or palliative care.⁵

What helps

Practical steps: the brown bag review

1. Gather everything. Put every prescription, over-the-counter medicine, vitamin, supplement, eye drop, cream and inhaler in a bag.
2. Make a list. Write each name, what it is for, who prescribed it, and how you take it. Keep the list in your wallet and bring it to every visit.⁵
3. Book a visit for the review. Ask your doctor or pharmacist to go through the bag with you once a year, and after any hospital stay.
4. Ask these questions: Do I still need this? Is it on the Beers list? Could it cause confusion, sleepiness or falls? Is there a safer option, including a non-drug one?⁵
5. Ask your drug plan whether you qualify for a free Medication Therapy Management review.¹¹
6. Make one change at a time, with your doctor's guidance, so you can tell what helped.
7. Report side effects quickly, and ask what side effects to watch for with any new medicine.⁵
8. Read labels on store-bought products. Many "PM" or nighttime products contain diphenhydramine.³

For family caregivers

• Be the medicine historian. Keep an up-to-date list, and note when new symptoms started compared with medicine changes.
• Go to appointments or join by phone, especially if your loved one has memory problems.
• Watch for sudden changes. Sudden confusion, sleepiness or falls after a new medicine needs a call to the doctor that day.
• Use one pharmacy so the pharmacist can check for interactions.
• Ask about deprescribing. Most doctors welcome a conversation about whether each medicine is still needed.²
• Help with organizing. Pill boxes, blister packs and reminders reduce missed or double doses. See Medication management in dementia.

Special situations

People living with dementia. People with dementia are more sensitive to medicines that act on the brain. Taking three or more such medicines together may raise the risk of falls, memory problems and death.² Antipsychotics carry a higher risk of stroke and death in people with dementia.³ See Medicines to avoid in dementia and Sleep medicines in dementia.

Delirium. Delirium is sudden confusion with poor attention that comes on quickly. A new medicine or a risky combination can be one cause. Sudden confusion always needs prompt medical care. See Dementia, depression or delirium?.

Grief and new sleeping pills. After a loss, people are sometimes given sleeping or "nerve" pills. Ask how long to take them and about safer options. See Grief and widowhood.

Alcohol. Alcohol mixes dangerously with many sleep, anxiety and pain medicines. See Alcohol and older adults.

Language barriers. Ask for an interpreter and for labels and instructions in your language. Bring a family member if that helps.

Frequently asked questions

My medicine is on the Beers list. Should I stop it?

No, not on your own. The list is a guide for a conversation, not an order to stop. It may still be the right medicine for you.⁵ Ask your doctor whether a safer option exists.

Is it safe to take an over-the-counter sleep aid?

Many contain diphenhydramine, which AGS advises older adults to avoid because it can cause confusion and other side effects.³ Ask your pharmacist before using one, and see Sleep changes with age.

I've taken a sleeping pill for 20 years. Is it too late to stop?

It is not too late to talk about it. Many older adults have tapered successfully with a slow plan and support.⁶ Your doctor can help you decide.

Could my memory problems be caused by a medicine?

They could. That is why a medicine review is part of any memory checkup. See Brain health and take the Normal aging or dementia quiz.

When to get help

Call your doctor the same day for new confusion, severe drowsiness, a fall, or a big change in mood after starting or changing a medicine.

Call 911 for sudden severe confusion, trouble breathing, extreme sleepiness or a possible overdose, or seizures.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.