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Medications to Watch Closely in Long-Term Care

The right drugs can improve quality of life, while the wrong ones can cause harm. Here’s what caregivers need to look for

10-minute read

Paul Wynn,

AARP

Published October 07, 2026

a person drinking a glass of water on top of a pill bottle with different pills around them

AARP (Getty Images, 4)

Key takeaways

Review the entire medication list with a health care professional for unnecessary drugs, duplicate therapies and side effects that may be affecting daily life.
Pay close attention to antipsychotics, benzodiazepines, opioids, sleep drugs and blood thinners. Ask whether each is still needed and if side effects outweigh the benefits.
If your loved one’s health changes suddenly, ask whether medications could be responsible and if their drug regimen should be reassessed.

When an older loved one moves into a long-term care facility, families often assume one thing is under control: their medications. But medication lists can become surprisingly complicated, particularly for people with multiple chronic conditions who see several doctors. Different clinicians may focus on different diseases without always stepping back to consider the need for a medication or the entire drug regimen — and that’s where problems often start.

For Amy Massingale, those risks became painfully clear after she moved her parents, George and Rosemary Massingale, from Texas to Oregon, into a memory care unit. Her mother, who had Lewy body dementia and Alzheimer’s disease, developed severe agitation and was prescribed medications to manage it. Amy, now 58, was particularly troubled by the use of the antianxiety drug Xanax, which she says made her mother’s agitation worse. She also felt staff too often turned to medication to manage symptoms rather than trying nonmedical approaches, such as music, to help calm her.

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Amy’s father, George, had Alzheimer’s but was gentle and easygoing, with little behavioral trouble. After Rosemary died at 78, however, the hospice team prescribed an antidepressant before George showed signs of depression. Despite Amy’s questions and concerns about the medication, he remained on treatment.

Later, near the end of his life, staff reported that George, at 81, had become “combative” while being dressed and obtained an order for the antipsychotic olanzapine without consulting the family. Amy found her father profoundly sedated and barely responsive after the medication was started. She insisted it be stopped, concerned that it was robbing the family of precious time with him.

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Then she discovered what had triggered the episode: George was still being made to wear tight compression stockings that had been prescribed months earlier, when he had swelling. Amy believes his resistance to the caregivers was an attempt to communicate that discomfort, and that a simple investigation of the underlying problem could have avoided the medication altogether.

That kind of careful questioning about medication safety can be especially important in long-term care, says Courtney Myers, an independent consultant pharmacist from Youngstown, Ohio, who works with medically complex adults. Overmedication is not the only concern. Each drug prescribed to a patient may have a legitimate purpose, but multiple medications can increase the risk of side effects. One study found that for older adults, taking four or more prescription medications daily was associated with a 1.5 to two times greater likelihood of recurrent falls, compared with fewer medications.

Caregivers can request a second opinion from another doctor or seek advice from a consultant pharmacist, who specializes in providing expert medication guidance to health care providers. In addition, caregivers should take advantage of the Medicare requirement that long-term care facilities conduct a monthly medication review.Also consider the annual wellness visit covered under Medicare Part B; you get one visit every 12 months at no cost when the provider accepts Medicare. That visit should include a review of current medications.

Here are seven medication categories that deserve a closer look.

1. Antipsychotics

Antipsychotic medications may be prescribed to treat serious psychiatric symptoms, but they also have been used in long-term care to manage agitation or difficult behaviors associated with dementia.

For older adults, these medications can cause sedation and other serious adverse effects, says Daniel Krinsky, a pharmacist and adjunct professor at the LECOM School of Pharmacy. If an older adult becomes much sleepier, less engaged or less steady after starting an antipsychotic or increasing its dose, caregivers should ask whether the medication could be a contributing factor.

2. Antianxiety medicines

Drugs such as lorazepam (Ativan) and diazepam (Valium) can reduce anxiety and sometimes help with other symptoms, but they can also cause drowsiness, impaired coordination and cognitive problems, increasing the risk of falls. Here’s even more concern when these drugs, technically called benzodiazepines, are combined with an opioid. Krinsky calls that combination a red flag because the medications can have additive effects, including increased sedation, dizziness, weakness, confusion, fall risk and even coma or death. Opioids alone can cause their own side effects (see below). If an antianxiety medication and an opioid appear on a loved one’s list, ask the care team to explain why each is needed and whether the combination remains appropriate. Never abruptly stop a benzodiazepine or other prescription medication without medical guidance. Some medications need to be reduced slowly to avoid side effects.

3. Opioids

Opioids can be exactly the right medication for an older adult with significant pain, such as after a fracture, surgery or other injury. But they can also cause problems that are especially concerning for older adults, including sedation, impaired balance, breathing problems and constipation. Opioids also carry a risk of dependence and addiction.

Myers says caregivers should look beyond the medication itself and pay attention to how it may be affecting their loved one’s day-to-day life. Is the person suddenly sleeping much more? Having difficulty going to the bathroom? Less able to participate in activities they once enjoyed?

The appearance of changes doesn’t necessarily mean a medication is causing them, says Myers. “But they can be clues that it’s time to ask the care team to take another look at the medication, including whether the dose is still appropriate and whether the benefits continue to outweigh the risks.”

4. Benadryl and other anticholinergic medications

Diphenhydramine, the active ingredient in Benadryl, is an antihistamine that many people assume is harmless because it is available over the counter (OTC).

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It can also turn up in combination products. For example, Tylenol PM contains diphenhydramine; a person may think they are taking a simple pain reliever when they are also taking an antihistamine promoted as a sedating sleep aid. It’s important to read the drug facts panel on the packaging to learn about active ingredients.

Benadryl, Tylenol PM and other OTC medicines are anticholinergic, meaning they dry things out and slow down the brain, bladder and digestive system. “The overall anticholinergic burden matters. An older adult taking several medications with these effects may be more vulnerable to confusion, constipation, urinary retention, blurred vision and falls,” says Danielle Backus, associate professor of pharmacy at Pacific University in Hillsboro, Oregon.

5. Sleep drugs

Sleep problems are common among long-term care residents, but reaching for medication isn’t always the best first step. Zolpidem (Ambien), for example, can produce prolonged drowsiness in some older adults. Krinsky says a medication that might normally wear off after six to eight hours can last considerably longer in an older person with reduced liver function. That can leave someone groggy the next morning when they’re getting out of bed or into a wheelchair — precisely when a fall could occur.

Before adding a sleep medication, ask what might be interfering with sleep. Caffeine, nighttime routines, late-night snacks and meals, pain, constipation, anxiety and environmental factors may all play a role. Nonmedication approaches are definitely worth trying, including turning off screens at least an hour before bedtime, keeping the bedroom cool, avoiding caffeine at least six hours before sleep and finishing large meals two to three hours before going to bed.

6. Blood thinners

Blood thinners include antiplatelet drugs such as clopidogrel (Plavix) and anticoagulants such as warfarin, apixaban (Eliquis) and rivaroxaban (Xarelto). They are essential for preventing dangerous clots, but they also carry potentially serious bleeding risks.

The important question is whether the reason for taking the medication is still present and whether the dose and use with other medications remain appropriate. For example, pain relievers, such as Advil and Motrin, can further increase bleeding concerns when taken with blood thinners.

7. Diuretics

Sometimes a medication can be medically appropriate but significantly impact an older person’s quality of life.

Myers saw this with a 71-year-old woman in assisted living who had complicated heart failure and was taking a high dose of furosemide (Lasix), a diuretic that helps the body get rid of extra salt and water. The medication made her need to urinate urgently, which was particularly difficult because she had trouble moving quickly enough to reach the bathroom.

Look at the whole medication list

Regular medication reviews shouldn’t focus only on whether a drug is on a list of potentially inappropriate medications. What is the medication doing to this person’s ability to live?

Sometimes the biggest problem isn’t one medication. It’s the accumulation of medications prescribed by different clinicians over time — called polypharmacy. Backus has seen patients remain on medications for years, even when the reason for taking them has changed. In one case, a patient had been taking two medications for dementia with essentially the same mechanism for several years — an oral drug and a patch — when ordinarily one or the other would be used. Backus recommends two online tools to track and streamline medications:

ACB Calculator (Anticholinergic Cognitive Burden Calculator): This user-friendly tool is perfect for family caregivers. Simply type in a medication to check its anticholinergic burden score — a metric that highlights drugs that may affect memory or clear thinking.
Deprescribing.org: Backus relies on this site for safe ways to reduce or stop certain medications, including antipsychotics, benzodiazepines, acid reflux drugs and diabetes medications. While it offers useful patient handouts, keep in mind that much of its technical material is written for health care providers.

Five questions caregivers should ask

When something changes — your loved one becomes sleepier, confused, dizzy, unsteady or simply “not like themselves” — don’t assume it’s just aging or the underlying disease. Ask the care team:

Why is each medication being prescribed?
What benefit are we expecting from the drug?
Could any medication be contributing to this change?
Are there medications that are no longer necessary or that could be reduced?
When should we reassess each medication and the dose?

For families who live far away, staying on top of medications can be more challenging. One option is to hire a professional caregiver to make regular visits to watch for changes. Families can also consider hiring a geriatric care manager, who can visit the facility, communicate with the care team and help the family keep track of changes in medications and their effects. These services are typically paid out of pocket, although some long-term care insurance policies may cover certain caregiving services.

If you’re not getting answers, Myers says, as a family member you can raise medication concerns with the staff. Patients also have the right to seek care from a different doctor or use telehealth when appropriate.

The goal isn’t to challenge every prescription or automatically reduce the number of medications. It is to make sure the medications continue to serve the person, rather than contribute to or cause problems. “Go with your gut,” says Myers. “It’s all about advocating for your loved one.”

Paul Wynn, a veteran health care writer, has spent over a decade immersed in the caregiving community, both as a family caregiver and as a journalist covering caregiving issues for national publications.

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