One-Third of Seniors with Cognitive Decline Take Risky Drugs

Imagine opening a medicine cabinet and finding a hidden hazard: pills that quietly dull memory, sway balance, and raise the odds of an emergency room visit. For many older adults with dementia or other cognitive disorders, that scene is more common than it should be.

Researchers at the University at Buffalo sifted through medication records for 2,796 community-dwelling Americans aged 65 and older and found a slow but meaningful shift. Between 2011 and 2022 the share of people with cognitive impairment taking at least one potentially harmful central nervous system drug dropped—from 39.3% to 29.3%—but that still leaves roughly one in three exposed.

Why does this matter? Because the culprits are familiar: benzodiazepines once prescribed for anxiety, sedative-hypnotics sold as sleep aids, anticholinergic drugs with a broad range of uses, and some antipsychotics. In older brains already struggling with memory and judgment, these medications can tip the scale toward falls, hospital admissions, worsening mental health, and even earlier mortality.

Haowen Hsu, PharmD, the study's lead author, puts it bluntly: these drugs act on the same central nervous system that is already vulnerable in people with cognitive disorders. Too much of that influence can be harmful rather than helpful.

About one in three older adults with cognitive impairment still takes at least one medication that could worsen cognition and increase health risks.

So what's changing? The study used the American Geriatrics Society’s Beers Criteria—a checklist clinicians use to flag potentially inappropriate medications for seniors—and projected the findings to represent roughly 29.7 million older Americans with cognitive problems over the study period. The analysis doesn’t nail down why prescribing declined, but experts point to growing awareness around geriatric medication safety, tighter prescribing guidance, and more frequent medication reviews.

Still, the remaining exposure is worrying because the harm is cumulative. Sedatives, anticholinergics, and other psychoactive drugs add up. This 'drug burden' has its own metric—the Drug Burden Index—that can help clinicians see the total sedative and anticholinergic load a patient carries. When that index is high, risk follows: more falls, more confusion, more trips to urgent care.

Deprescribing is emerging as an answer. It’s not abrupt or dramatic. Often it means small, intentional steps: lowering a dose, stretching the time between doses, switching to a safer therapy, or tapering a drug off entirely. For families and clinicians, the process can be delicate—balancing symptom relief against long-term safety—but the potential gains include fewer hospitalizations, improved thinking, and preserved independence.

This research reminds clinicians, caregivers, and patients that prescription lists are not static. They are living documents that deserve regular review, especially when cognition is declining. Asking the simple questions—Does this drug still help? Could a safer alternative work?—can change outcomes.

Policy and practice will have to keep pace: wider use of medication-review tools, better training on geriatric pharmacology, and research that links deprescribing strategies to concrete reductions in emergency visits and mortality. The message is clear and urgent: medication safety in older adults with cognitive disorders is a solvable problem, if we treat it like one.