Sleeping pills and anti-anxiety meds
Almost a third of older American adults take sedatives. These include prescription sleeping pills such as zolpidem (Ambien) and eszopiclone (Lunesta), as well as anti-anxiety medications such as alprazolam (Xanax) and diazepam (Valium). And use of such drugs carries a lot of risk for this age group. “Since they stay in seniors’ bodies for longer, they're more susceptible to side effects like falls, dizziness, confusion and memory problems,” Hochman says. Taking them doubles the risk of falls and hip fractures.
What to do: It's fine to pop an Ambien if it's a once-in-a-while event, for example, if you need to catch some shut-eye on an especially long flight. But if you find that you're relying on sedatives for more than a day or two, talk to your doctor. “You may have an underlying condition such as depression or anxiety that should be treated,” Steinman says. Another option: cognitive-behavioral therapy (CBT), a form of behavioral treatment that focuses on changing habits such as those that disrupt sleep. The American Academy of Sleep Medicine (AASM) now recommends CBT over sleep drugs as the treatment of first resort for chronic insomnia. This type of short-term counseling usually requires only six one-hour sessions and is often covered by insurance. Some sleep centers offer CBT; to find one accredited by AASM, go to sleepcenters.org.
Certain over-the-counter antihistamines
Products such as nighttime cold medications that contain the antihistamines diphenhydramine (Benadryl) and chlorpheniramine (AllerChlor, Chlor-Trimeton) can cause symptoms such as confusion, blurred vision, constipation, trouble urinating and dry mouth. And long-term use may also raise your risk of dementia, according to a study published in JAMA Internal Medicine. This is because these medicines are anticholinergic drugs, which means they block the action of acetylcholine, a substance in the brain linked to learning and memory.
What to do: Always read the ingredient labels on all the OTC cough, cold and allergy medications you buy, Hochman says (diphenhydramine is often found in nighttime cold medicines, for example, because it dries up nasal secretions while also making you sleepy). If you're plagued with something like hay fever, look for an OTC antihistamine that contains ingredients such as loratadine (Claritin) or cetirizine (Zyrtec), which don't have anticholinergic effects, he advises. Another option: allergy shots. When people ages 65 to 75 got jabbed for three years, it relieved symptoms by 55 percent and decreased the amount of allergy meds they needed by 64 percent, according to a 2016 study published in the Annals of Allergy, Asthma & Immunology.
Some diabetes medications
It's important to get your blood sugar under control if you have type 2 diabetes, because you're especially vulnerable to the disease's complications when you're older. But certain anti-diabetes drugs, known as long-acting sulfonylureas, need to be avoided, Hochman says. That's because they can cause dangerously low blood sugar. These include glyburide (Diabeta, Micronase) and chlorpropamide (Diabinese).
What to do: If you have type 2 diabetes, metformin should be the first-line treatment, Hochman says, along with lifestyle measures like losing weight and exercising. Most of the time, these steps are enough to get your blood sugar under control. If not, other diabetes medications can help. But if your doctor feels that's not enough, it's time to have a conversation. “Some doctors are very aggressive when it comes to blood sugar control, but in older adults, there's good evidence to suggest we don't need to be as strict,” Hochman says. “In fact, we think that in this age group, lowering their blood sugar too aggressively can increase risk of death from heart disease."