Why Pain Relievers Can Be Harder on Your Body After 60

1. Slower Metabolism Alters Drug Breakdown

As we age, our bodies undergo significant changes in metabolism that directly affect how pain relievers are processed. One of the most important organs involved is the liver, which is responsible for breaking down and detoxifying many medications. After age 60, liver blood flow typically decreases, and enzyme activity may slow. This means drugs like acetaminophen and certain NSAIDs can linger in the bloodstream longer, increasing the potential for side effects and toxicity.
Older adults may not experience obvious symptoms when their bodies begin to accumulate medications, making regular monitoring essential. Common warning signs of trouble include persistent nausea, confusion, jaundice, or unexpected fatigue. If you or a loved one are taking pain relievers, ask your healthcare provider about routine liver function tests and whether lower doses might be appropriate.

To learn more about liver changes and medication safety in older adults, visit the National Institute on Aging’s guide.

2. Reduced Kidney Function Increases Risk

The kidneys play a vital role in filtering waste products and excess medications from the bloodstream. As people age, kidney function naturally declines—even in the absence of disease. In fact, by age 60, the kidneys may filter blood at only half the rate of a healthy young adult. This slowed filtration means pain relievers such as ibuprofen, naproxen, and certain opioids can build up in the body, raising the risk of side effects like confusion, dizziness, or even kidney damage.
Older adults are especially prone to drug accumulation, which can go unnoticed until symptoms become severe. If you notice swelling in the legs, changes in urination, or new onset of confusion after starting or increasing pain medication, it’s crucial to consult your doctor promptly.
Routine kidney function tests can help monitor how well your body is handling medications, and your healthcare provider may recommend dose adjustments or alternative therapies as needed.

For more information on how aging affects the kidneys and medication safety, see the National Kidney Foundation’s factsheet on aging and chronic kidney disease.

3. Thinner Stomach Lining Heightens Ulcer Risk

As we age, the protective lining of the stomach naturally becomes thinner and less resilient. This change makes older adults far more susceptible to irritation and damage from nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen. According to the Clinical Gastroenterology and Hepatology Journal, people over 60 who take NSAIDs are up to four times more likely to develop stomach ulcers or gastrointestinal bleeding compared to younger adults.

Never take NSAIDs on an empty stomach
Ask your doctor about protective medications like proton pump inhibitors if you require long-term pain relief
Be alert for warning signs such as black stools, abdominal pain, or unexplained fatigue

For additional tips on preventing NSAID-related stomach problems, visit the National Institute of Diabetes and Digestive and Kidney Diseases.

4. Increased Sensitivity to Side Effects

Aging brings about changes in the nervous system and overall physiology that can make older adults more sensitive to medication side effects. Diminished nerve conduction and altered neurotransmitter levels may increase the risk of dizziness, drowsiness, and confusion—even at lower doses of pain relievers. Older adults are also more likely to experience severe responses, such as a sudden drop in blood pressure or heightened risk of falls, which can have devastating consequences.
Tracking symptoms is a practical way to catch side effects early. Keep a daily log of any new or worsening symptoms, including changes in mood, balance, or alertness. Share this log with your healthcare provider during regular check-ups. Enlist the help of family or caregivers to observe for subtle changes, as older adults may not always notice or report symptoms themselves.

For more guidance on medication side effects in the elderly, see the Health in Aging Foundation’s medication safety tips.

5. Polypharmacy: Multiple Drugs, Multiple Risks

Polypharmacy—the use of multiple medications at the same time—is increasingly common among adults over 60. Managing several prescriptions, including pain relievers, dramatically increases the risk of harmful drug interactions and side effects. According to the Centers for Disease Control and Prevention (CDC), nearly 40% of older adults take five or more medications daily. Each additional drug raises the chance of adverse reactions, confusion, and even hospitalizations.
Pain relievers can interact unpredictably with medications for high blood pressure, diabetes, or heart disease. For example, certain NSAIDs may reduce the effectiveness of antihypertensives or raise bleeding risk when combined with blood thinners. To minimize risks, it’s crucial to schedule regular medication reviews with your healthcare provider or pharmacist. Bring an up-to-date list of all prescriptions, over-the-counter drugs, and supplements to every appointment.

Ask if all medications are still needed
Review for possible drug interactions
Discuss safer alternatives if concerns arise

For more information on managing multiple medications, visit the National Institute on Aging’s polypharmacy resource.

6. Slower Gastrointestinal Transit

With age, the gastrointestinal (GI) tract slows down, affecting how pain relievers are absorbed and processed. This slower transit means medications can remain in the digestive system longer, increasing the risk of side effects and unpredictable absorption. Clinical studies have shown that older adults often experience delayed or erratic medication effects, especially with opioids and certain NSAIDs. One common and troublesome result is constipation, which is particularly frequent with opioid pain relievers.
Constipation can cause discomfort, appetite loss, or even more serious complications like bowel obstruction if left unmanaged. To help prevent this, maintain a diet high in fiber, stay well-hydrated, and incorporate gentle physical activity such as walking.
If constipation persists after starting a new pain medication, talk with your healthcare provider about potential solutions, including stool softeners or alternative pain management strategies.

Monitor bowel movements regularly
Report any significant changes promptly
Avoid overusing laxatives without medical advice

For additional guidance on managing opioid-induced constipation and digestive health in older adults, visit the National Cancer Institute’s guide on constipation.

7. Reduced Body Water Content

As we grow older, our bodies naturally lose water content and muscle mass while accumulating more fat. This shift in body composition has a significant impact on how pain relievers are distributed and concentrated. Many medications dissolve and travel through body water; with less water available, drug concentrations can rise more quickly, increasing the risk of side effects and toxicity—especially for water-soluble drugs like acetaminophen and certain NSAIDs.
Older adults are also more prone to dehydration, which further intensifies medication effects and can lead to confusion, dizziness, and kidney problems. Maintaining good hydration is crucial for safely processing medications and supporting overall health.

Drink water regularly throughout the day, not just when you feel thirsty
Limit caffeine and alcohol, which can contribute to dehydration
Monitor for signs of dehydration such as dry mouth, dark urine, and fatigue

If you’re unsure about your hydration status or the appropriate fluid intake for your health conditions, consult your healthcare provider. For more information, see the National Institute on Aging’s guide to staying hydrated.

8. Lower Muscle Mass Alters Drug Storage

Muscle mass naturally decreases with age, a condition known as sarcopenia. This reduction changes how pain relievers are stored and distributed within the body. Since many drugs, including certain pain medications, are stored in muscle tissue before being metabolized, less muscle means less storage capacity. As a result, medications may remain in the bloodstream longer, increasing the risk of side effects and toxicity.
Older adults with lower muscle mass can experience more pronounced effects from standard doses of pain relievers. Dosage adjustments may be necessary, especially for medications that have a narrow therapeutic range or are known to accumulate in the body.
It’s important to discuss your changing body composition with your healthcare provider. A personalized approach, taking into account muscle loss and overall frailty, helps ensure medication safety.

Ask your doctor if your current dose is appropriate for your age and body composition
Monitor for prolonged or unusual drug effects and report them promptly
Review all medications regularly to avoid unnecessary risks

For more on age-related muscle loss and medication effects, see the National Institutes of Health’s review on sarcopenia and drug pharmacokinetics.

9. Diminished Liver Enzyme Activity

Liver enzymes are responsible for breaking down and converting medications into forms the body can use or eliminate. With age, the activity of these enzymes—such as those in the cytochrome P450 family—tends to decrease. This decline means drugs like acetaminophen, codeine, and some NSAIDs are metabolized more slowly, leading to higher concentrations in the blood and a greater chance of adverse effects.
For example, an older adult taking a commonly prescribed opioid may experience stronger sedation or confusion than a younger person at the same dose. Similarly, slower processing of acetaminophen can raise the risk of liver toxicity, even with doses that would be considered safe for a younger adult.
Case studies have shown that older adults on multiple medications metabolized through the liver are especially prone to drug interactions and complications. It is crucial to have regular liver function tests and to discuss all medications—including over-the-counter pain relievers and supplements—with your healthcare provider.

For additional details on how aging affects liver enzyme function and medication safety, visit the National Institutes of Health’s review on drug metabolism in the elderly.

10. Chronic Health Conditions Complicate Use

Many adults over 60 manage chronic health conditions such as diabetes, heart disease, hypertension, or kidney issues. These conditions can interact unpredictably with pain relievers, making medication management even more complex. For example, NSAIDs can raise blood pressure and worsen heart failure, while certain pain medications may affect blood sugar control in people with diabetes.
If you have existing health issues, pain relievers may also interact with other essential medications, leading to dangerous side effects or reduced effectiveness. Personalized care is crucial: your healthcare provider should always be informed about every medication and supplement you take, as well as any changes in your health status.

Schedule regular medication reviews with your doctor or pharmacist
Report new symptoms promptly, especially if you notice changes in heart rate, blood pressure, or blood sugar
Ask about safer alternatives or non-drug therapies for pain relief

For more on how chronic conditions can affect medication use, see the CDC’s resource on polypharmacy and chronic diseases.

11. Higher Risk of Gastrointestinal Bleeding

Older adults are at a significantly increased risk of gastrointestinal (GI) bleeding when taking certain pain relievers, particularly NSAIDs like ibuprofen, naproxen, and aspirin. Recent research published in the BMJ found that adults over 65 who regularly use NSAIDs are more likely to experience serious GI bleeding, sometimes requiring hospitalization or even becoming life-threatening.
This heightened risk is due to both age-related thinning of the stomach lining and reduced ability to recover from minor injuries within the digestive tract. Blood thinners or corticosteroids taken for other health conditions can further amplify these dangers.

Warning signs include black or tarry stools, vomiting blood, abdominal pain, and unexplained weakness or dizziness.
Seek immediate medical help if you notice any of these symptoms.
Discuss preventive strategies—such as using the lowest effective dose or adding protective medications—with your healthcare provider.

For more information about the risks and prevention of GI bleeding with pain relievers, visit the American Gastroenterological Association’s NSAIDs and digestive health resource.

12. Delayed Drug Clearance Leads to Accumulation

As we age, our bodies become less efficient at eliminating medications. This delayed drug clearance is primarily due to reduced kidney and liver function, meaning pain relievers may linger much longer in the bloodstream compared to younger adults. For instance, a pain medication that is typically cleared within hours in a 30-year-old could take significantly longer in someone over 60, raising the risk of drug accumulation and toxicity with repeated use.
This buildup can manifest as more intense side effects, such as confusion, drowsiness, or even life-threatening reactions like respiratory depression in the case of opioids. Older adults are also more susceptible to accidental overdose, especially if they are unaware of how long medications remain active in their systems.

Monitor for unusual or prolonged effects after taking any pain reliever
Adhere strictly to prescribed dosing intervals, and never double up on missed doses
Consult your healthcare provider if you suspect medication buildup or toxicity

To understand more about age-related changes in drug clearance, see this National Institutes of Health review on pharmacokinetics in the elderly.

13. More Pronounced Blood Pressure Changes

Certain pain relievers, especially NSAIDs, can have a stronger impact on blood pressure in older adults than in younger individuals. As arteries stiffen and kidney function diminishes with age, the body becomes less able to compensate for these drug-induced changes. NSAIDs, in particular, may cause fluid retention and disrupt sodium balance, leading to elevated blood pressure or even exacerbating existing hypertension. According to the American Heart Association, older adults should be especially cautious when using these medications.
At-home monitoring can help catch issues early. Use a reliable home blood pressure cuff to check your readings regularly, especially after starting or changing pain medication. Keep a written log to share with your healthcare provider at each visit.

Monitor for symptoms such as headaches, dizziness, or sudden swelling
Inform your doctor of any significant changes in blood pressure
Ask about alternatives if you have a history of hypertension or heart problems

For more information on pain relievers and blood pressure, visit the American Heart Association’s guide to NSAIDs and hypertension.

14. Reduced Resilience to Liver Injury

The aging liver is more vulnerable to damage from pain medications, especially acetaminophen (Tylenol). Over time, liver cells lose some of their regenerative capacity, and the organ’s ability to detoxify harmful substances diminishes. This reduced resilience means that even standard doses of acetaminophen can sometimes overwhelm the liver’s protective mechanisms, leading to injury or, in severe cases, acute liver failure. The risk is even greater if other factors—like alcohol consumption or pre-existing liver disease—are present.
According to the U.S. Department of Veterans Affairs, older adults are disproportionately affected by acetaminophen toxicity, often because they are unaware of the lower dose recommendations for their age group.

Follow dosing instructions carefully and never exceed the recommended daily amount
Avoid combining acetaminophen-containing products unless advised by your doctor
Limit alcohol intake to further protect liver health

For more on protecting your liver while managing pain, see the VA’s acetaminophen safety guide.

15. Greater Risk of Falls and Fractures

Pain relievers, especially opioids and certain NSAIDs, can cause side effects such as dizziness, drowsiness, and impaired coordination. In older adults—who may already struggle with balance or mobility—these effects significantly increase the risk of falls and resulting fractures. According to the Centers for Disease Control and Prevention (CDC), falls are the leading cause of both fatal and nonfatal injuries in adults over 65, and medications play a major role in many incidents.
Even mild sedation or confusion can be enough to trigger a fall, especially when combined with poor vision or muscle weakness. The consequences can be severe, ranging from hip fractures to lengthy hospitalizations and loss of independence.

Review medications regularly to minimize drugs that affect alertness or balance
Ensure your home is free of tripping hazards and well-lit, especially at night
Use assistive devices (like canes or grab bars) as recommended by your doctor or physical therapist

For a comprehensive guide to preventing falls and managing medication risks, visit the CDC’s STEADI patient resources.

16. Unexpected Cognitive Effects

Older adults are particularly vulnerable to the cognitive side effects of pain relievers, especially opioids and certain over-the-counter medications containing diphenhydramine (such as some “PM” pain formulas). These drugs can trigger confusion, memory lapses, and even delirium—effects that are often mistaken for normal aging or early dementia. For example, studies published in the Journal of the American Geriatrics Society have shown that opioid use in older adults is associated with a higher risk of cognitive impairment and acute confusion.
Symptoms may present suddenly, with the individual appearing unusually forgetful, disoriented, or unable to follow conversations. Cognitive changes can also develop slowly, making them harder to identify. Regular cognitive screening and prompt reporting of any mental changes are essential for early intervention.

Monitor for sudden confusion, forgetfulness, or agitation after starting or changing pain medication
Schedule routine cognitive assessments with your healthcare provider
Involve family or caregivers in observing day-to-day changes

For more on medication-induced cognitive changes, refer to the Health in Aging Foundation’s guide on medications and memory.

17. Higher Likelihood of Allergic Reactions

As the immune system ages, it can become both weaker and more unpredictable, making older adults more prone to allergic reactions—even to medications they’ve tolerated in the past. Pain relievers, particularly NSAIDs and certain opioids, are among the most common culprits for drug-induced allergies in seniors. Symptoms can range from mild rashes and itching to severe, life-threatening reactions such as anaphylaxis.
Older adults may also develop sensitivities to inactive ingredients or preservatives in over-the-counter pain medications. According to the American Academy of Allergy, Asthma & Immunology, the risk of medication allergies increases with age and the number of medications taken.

Watch for warning signs such as hives, swelling, difficulty breathing, or sudden drop in blood pressure
Stop the medication immediately and seek emergency care if severe symptoms occur
Inform all healthcare providers of any known drug allergies or past reactions

For further details on drug allergies and how to respond, review the AAA&I’s medication allergy resource.

18. Difficulty Recognizing Overdose Symptoms

Overdose symptoms can be especially subtle in older adults, making prompt recognition and response more challenging. Age-related changes in the nervous system and reduced sensitivity to pain or discomfort can mask classic overdose signs. For example, instead of obvious drowsiness or loss of consciousness, an older person might simply become confused, weak, or experience a sudden change in behavior. Case studies, such as those highlighted by the CDC, show that older adults are often treated for overdoses later than younger people because early symptoms are missed or mistaken for normal aging.
It is crucial for older adults and their caregivers to know the less obvious warning signs, including persistent nausea, slurred speech, unsteady gait, or unexplained falls. If there is any suspicion of overdose—whether from opioids, acetaminophen, or NSAIDs—immediate medical attention is essential.

Err on the side of caution: Seek emergency help if symptoms are unusual or rapidly worsening
Keep medication packaging or a list available for healthcare professionals
Educate family and caregivers on signs of overdose and when to call 911

For more on overdose risks and emergency response, visit the CDC’s older adult overdose prevention page.

19. Increased Susceptibility to Drug Interactions

As we age, our bodies process medications differently, and the likelihood of taking multiple drugs—known as polypharmacy—rises sharply. These factors combine to make drug interactions far more common and dangerous for older adults. Age-related changes in liver and kidney function can slow the breakdown and elimination of medications, while reduced body mass and water content alter how drugs are distributed.
For example, taking NSAIDs with blood thinners like warfarin significantly increases the risk of bleeding. Similarly, combining opioids with certain sedatives or sleep aids can heighten sedation or respiratory depression. Real-world data from the FDA shows that older adults are more likely to be hospitalized due to adverse drug interactions than any other age group.

Keep an up-to-date list of all medications, including over-the-counter drugs and supplements
Share this list with every healthcare provider at each visit
Ask your pharmacist to review for potential interactions before starting any new medication

For additional guidance and safety tips, visit the FDA’s polypharmacy and drug interaction resource.

20. Decreased Ability to Filter Toxins

The body’s ability to filter and eliminate toxins—including the byproducts of pain relievers—naturally declines with age. Healthy kidneys and liver work together to process and remove these substances efficiently. However, in older adults, even subtle declines in organ function can cause toxins from medications to accumulate, raising the risk of side effects and toxicity.
For example, studies show that kidney filtration rate (GFR) drops steadily with age, sometimes by as much as 50% by the time someone reaches their 70s. In healthy adults, the body typically clears most pain relievers within hours or a day. In contrast, those with impaired filtration may retain these drugs and their metabolites much longer, leading to prolonged or intensified effects.

Request regular kidney and liver function tests if you take pain relievers long-term
Report new or worsening symptoms promptly to your healthcare provider
Use the lowest effective dose for the shortest duration necessary

To learn more about age-related changes in toxin clearance and medication safety, visit the National Kidney Foundation’s resource on aging and kidney health.

21. Slower Healing from Tissue Damage

Aging slows the body’s natural healing processes, making recovery from injuries—including those caused by pain relievers—much more challenging. Common side effects of NSAIDs include stomach ulcers and gastrointestinal bleeding, while both NSAIDs and corticosteroids can increase the risk of bruising or skin tears. In older adults, the repair of damaged tissues is not only slower but may also be incomplete, raising the risk of complications and long-term discomfort.
For example, a stomach ulcer in a younger person might heal in a few weeks with appropriate treatment, but the same injury in an older adult could take months and carry a higher chance of infection or recurrent bleeding. Even minor bruises from pain medications can linger and become sites of infection, especially if mobility is limited.

Report persistent sores, bruises, or abdominal pain to your healthcare provider
Ask about medications or supplements that may support healing or reduce risk
Practice gentle skin care and nutrition to support tissue repair

For more on the challenges of healing with age, visit the Johns Hopkins Medicine guide to aging and wound care.

22. More Pronounced Impact of Drug Errors

Medication errors—such as taking the wrong dose, missing a dose, or accidentally doubling up—can have much more severe consequences in older adults. After 60, the margin for error narrows due to slower metabolism, reduced organ function, and increased drug sensitivity. Even small mistakes with pain relievers can lead to toxicity, dangerous side effects, or treatment failure.
For instance, an extra dose of acetaminophen or NSAIDs may overwhelm aging kidneys or liver, while missing a dose could result in unmanaged pain that impairs mobility or increases fall risk. Studies from the FDA highlight that older adults are disproportionately affected by medication errors, often due to complex regimens and memory challenges.

Use a pill organizer or electronic reminder system to keep track of doses
Keep a written medication schedule visible and update it after any changes
Involve family or caregivers in double-checking doses if needed

For more medication management strategies, visit the FDA’s medication error resource.

23. Changes in Taste and Smell Affect Compliance

With age, many people experience diminished senses of taste and smell—a condition known as presbyosmia and hypogeusia. These changes can make medications, including pain relievers, taste more bitter or metallic, discouraging regular use. In clinical practice, it’s not uncommon for older adults to skip doses or stop medications altogether because of unpleasant flavors or difficulty swallowing pills with strong odors.
Research from the National Institutes of Health highlights that sensory loss can directly impact medication adherence, as individuals may not recognize spoiled liquid medications or may become averse to certain formulations. This can undermine pain management and increase the risk of uncontrolled symptoms or medication errors.

Ask your pharmacist about alternative forms, such as coated pills, liquids, or dissolvable tablets
Use a beverage or food (if allowed) to mask unpleasant tastes when taking oral medications
Discuss persistent compliance issues with your healthcare provider, who may adjust your regimen

For more on sensory changes and medication compliance, see this NIH review on taste, smell, and medication adherence in older adults.

24. Difficulty Swallowing (Dysphagia)

Dysphagia, or difficulty swallowing, is a common concern among older adults due to age-related muscle weakness, neurological conditions, or structural changes in the throat. This issue complicates the use of pain relievers—especially large tablets or capsules—by increasing the risk of choking or aspiration. According to the National Institute on Aging, millions of seniors struggle with swallowing medications safely, which can lead to skipped doses or improper pain management.
Practical workarounds are available. Many pain relievers come in alternative formulations such as liquid suspensions, chewable tablets, dissolvable strips, or patches. Pharmacists can also advise whether a pill can be safely crushed or split, but this should never be done without professional guidance, as some medications are time-released or coated for stomach protection.

Ask your healthcare provider about switching to easier-to-swallow forms if you have dysphagia
Use plenty of water and an upright posture when taking oral medications
Consult a speech-language pathologist for tailored swallowing strategies if needed

For more tips on managing dysphagia and medication use, visit the NIA’s dysphagia resource page.

25. Greater Vulnerability to Liver Cirrhosis

Older adults face an increased risk of developing liver cirrhosis from long-term or high-dose use of certain pain relievers, especially acetaminophen and some NSAIDs. As the liver ages, its ability to repair itself and regenerate healthy tissue is diminished. Chronic exposure to toxic substances—even at doses that may be considered safe in younger people—can lead to scarring (fibrosis) and eventually cirrhosis. According to the U.S. Department of Veterans Affairs, acetaminophen toxicity is a leading cause of acute liver failure, and older adults are particularly susceptible after years of regular use.
Prevention is key. Always follow recommended dosing guidelines, avoid combining multiple products containing acetaminophen, and minimize alcohol intake. If you have underlying liver disease or a history of heavy pain reliever use, request regular liver function tests and discuss safer pain management alternatives with your healthcare provider.

Stick to the lowest effective dose for the shortest duration possible
Avoid self-medicating with over-the-counter pain relievers for long periods
Seek medical advice if you notice jaundice, swelling, or persistent fatigue

For more on cirrhosis risks and prevention, see the VA’s acetaminophen and liver health guide.

26. Altered Blood-Brain Barrier

With age, the blood-brain barrier—the crucial filter that protects the brain from toxins and medications in the bloodstream—can become less effective. This age-related permeability allows more of certain pain medications, especially opioids and some NSAIDs, to enter the central nervous system. As a result, older adults may experience more pronounced brain-related side effects, such as confusion, dizziness, sedation, and even hallucinations, at doses that are well-tolerated by younger people.
Research highlighted by the National Institutes of Health shows that the structural and functional changes in the blood-brain barrier with aging can lead to increased sensitivity to centrally acting drugs. This may explain why older adults are more susceptible to falls, delirium, and cognitive changes after starting or adjusting pain medications.

Start with the lowest possible dose of any new pain medication
Monitor for unusual mental or emotional changes and report them promptly
Avoid medications with strong central effects unless absolutely necessary

For more on the aging blood-brain barrier and medication safety, see this NIH review on barriers and brain health.

27. More Severe Drug-Induced Constipation

Constipation is a well-known side effect of many pain relievers, especially opioids and some NSAIDs. For older adults, this problem is often more severe and persistent due to age-related changes in gastrointestinal motility, reduced physical activity, and lower fluid intake. The colon naturally slows with age, making it even harder for the body to move stool efficiently when on constipating medications.
Drug-induced constipation can lead to discomfort, abdominal pain, decreased appetite, and even serious complications like fecal impaction or bowel obstruction. Studies from the National Institutes of Health highlight that older adults taking opioids for chronic pain are at a much higher risk for severe constipation than younger people on the same medications.

Increase dietary fiber with fruits, vegetables, and whole grains
Stay hydrated by drinking water throughout the day
Discuss preventive options such as stool softeners or prescription medications with your provider

For additional tips on managing constipation from pain medications, visit this National Cancer Institute resource.

28. Increased Risk of Heart Complications

NSAIDs and some other pain relievers can significantly increase the risk of heart complications in older adults, especially those with existing cardiovascular conditions. NSAIDs may elevate blood pressure, promote fluid retention, and increase the risk of heart attack or stroke. According to the U.S. Food & Drug Administration (FDA), even short-term use of NSAIDs can pose dangers for seniors, and the risks grow with longer use or higher doses.
Older adults are also more likely to have underlying health problems, such as arrhythmias or congestive heart failure, which pain relievers can exacerbate. Symptoms may be subtle at first—such as swelling in the ankles, shortness of breath, or unexplained fatigue—but can quickly escalate.

Have your heart health screened regularly if you need long-term pain management
Report any new chest pain, swelling, or palpitations to your doctor immediately
Discuss safer alternatives or dose adjustments if you have a history of heart disease

For more on heart risks and pain relievers, see the FDA’s NSAID safety warning.

29. Less Reliable Pain Signals

Aging can blunt the body’s ability to perceive and report pain accurately—a phenomenon rooted in changes to nerve function and the brain’s processing of pain signals. As a result, older adults may not feel or communicate pain from medication side effects or complications as clearly as younger individuals. For example, a serious stomach ulcer or heart problem could present with mild or vague discomfort rather than the sharp pain expected.
This altered pain perception can delay diagnosis and treatment, increasing the risk of severe outcomes. It’s also possible to overlook subtle signs of drug toxicity or injury, such as persistent tiredness, mild confusion, or changes in appetite. Routine health checks and open communication with healthcare providers are essential to catch these issues early.

Schedule regular physical exams and medication reviews, even when you feel well
Pay attention to new or unusual symptoms, no matter how mild
Encourage honest conversations about pain and discomfort with your care team

For further reading on pain perception changes in older adults, see this NIH review on pain assessment in the elderly.

30. Reduced Skin Integrity and Bruising

The skin naturally becomes thinner, drier, and less elastic with age, making it more susceptible to bruising and injury. Pain relievers such as NSAIDs and blood-thinning medications can exacerbate these issues by increasing bleeding risk and slowing clot formation. Even minor bumps or pressure can lead to large, painful bruises or persistent skin damage in older adults.
According to the American Academy of Dermatology, fragile skin is a common concern among seniors and requires special care, especially when medications further compromise skin integrity.

Avoid unnecessary trauma by using soft clothing and padding on furniture edges
Moisturize daily to support skin health and prevent cracking
Monitor for unexplained bruises or slow-healing wounds and report them to your healthcare provider

For more strategies to protect aging skin and reduce bruising risks with medications, refer to the AAD’s guide to aging skin care.

31. Impaired Thermoregulation

Older adults often experience impaired thermoregulation—the body’s ability to maintain a stable internal temperature—due to age-related changes in skin, blood vessels, and sweat glands. Pain relievers such as NSAIDs and acetaminophen can further disrupt this delicate balance by altering how the body responds to heat or cold and masking fever or other temperature-related warning signs.
For example, NSAIDs may blunt fever in response to infection, delaying diagnosis and appropriate treatment. In hot weather, certain pain medications can increase the risk of heat exhaustion or heat stroke, while in cold conditions, they may reduce the body’s ability to warm itself. Subtle temperature shifts can also be harder to notice, putting seniors at greater risk for complications.

Monitor body temperature regularly, especially when feeling unwell or during extreme weather
Dress appropriately for the climate and avoid excessive heat or cold exposure
Report persistent chills, sweats, or fever to your healthcare provider

For more on thermoregulation and medication effects in older adults, see this NIH review on temperature regulation and the elderly.

32. Sleep Disruption from Medication

Sleep problems are common among older adults, and certain pain relievers can make these issues worse. Some NSAIDs and combination products with caffeine or decongestants may cause restlessness or make it harder to fall asleep. Opioids can disrupt sleep architecture, leading to lighter, less restorative sleep and frequent awakenings throughout the night. According to the Sleep Foundation, the elderly are especially vulnerable to medication-induced sleep disturbances, which can further impact mood, memory, and daytime function.
It’s important to recognize when pain medications are affecting sleep quality so that alternatives or timing adjustments can be considered.

Take pain relievers earlier in the day if possible, to minimize nighttime effects
Practice good sleep hygiene: keep a regular bedtime, limit screen time, and create a comfortable sleep environment
Inform your healthcare provider about ongoing sleep issues for further evaluation and support

For more on pain medication and sleep in older adults, see the Sleep Foundation’s guide to pain and sleep.

33. Increased Risk of Depression

There is growing evidence that certain pain relievers, particularly opioids and some long-term NSAID use, are linked to mood changes and an increased risk of depression in older adults. Chronic pain itself is a major risk factor for depression, but painkillers can further complicate mood regulation by impacting neurotransmitters like serotonin and dopamine. Studies reported by the National Institutes of Health indicate that older adults taking opioids for extended periods are significantly more likely to experience depressive symptoms than those not using these medications.
Symptoms may include persistent sadness, loss of interest, changes in appetite, or sleep disturbances. Because mood changes can develop gradually, they are sometimes overlooked or attributed to aging.

Monitor for new or worsening depression after starting or increasing pain medication
Maintain regular contact with your healthcare provider to discuss mental health concerns
Seek support from friends, family, or mental health professionals if you notice mood changes

For further information on the connection between pain medication and depression in seniors, visit this NIH review on opioids and depression.

34. Greater Susceptibility to Respiratory Depression

Older adults are particularly vulnerable to respiratory depression—a dangerous slowing of breathing—caused by opioid pain relievers and, less commonly, other sedating medications. Aging lungs and decreased muscle strength make it harder to compensate for the depressant effects of these drugs, increasing the risk of low oxygen levels or even respiratory failure. According to the Centers for Disease Control and Prevention (CDC), seniors are at higher risk for fatal opioid overdoses, often due to unrecognized or untreated respiratory depression.
Warning signs include shallow or slowed breathing, blue-tinged lips or fingertips, confusion, and difficulty waking up. These symptoms can develop gradually and may be mistaken for normal fatigue or illness, making vigilance essential for both patients and caregivers.

Take the lowest effective opioid dose and avoid combining with other sedatives unless advised by your doctor
Monitor for signs of slow or irregular breathing and seek emergency help immediately if they occur
Discuss naloxone (an opioid reversal drug) with your provider if you use prescription opioids

For additional information, visit the CDC’s opioid safety resource for older adults.

35. Increased Impact on Vision

Older adults often face natural declines in vision due to conditions like cataracts, glaucoma, or macular degeneration. Certain pain relievers can exacerbate these changes. For example, NSAIDs and corticosteroids may increase the risk of cataract formation or raise intraocular pressure, potentially worsening glaucoma. Opioids and some muscle relaxants can also cause blurred vision or difficulty focusing, especially soon after starting or increasing a dose. Real-world cases reported by the American Academy of Ophthalmology highlight that older adults on pain medications are more likely to experience visual disturbances that can impair daily activities and increase fall risk.
It is important to monitor for new or changing vision problems after beginning or adjusting pain reliever therapy. Routine eye exams and open communication with both your primary care provider and eye doctor can help catch and address issues early.

Schedule regular eye exams and report sudden changes in vision promptly
Use adequate lighting at home to minimize accidents due to reduced vision
Ask about medication alternatives if you notice persistent blurry vision or eye discomfort

For more on medication-related vision changes, see the AAO’s guide to drug side effects and the eyes.

36. Delayed Elimination of Drug Metabolites

As we age, our bodies not only process medications more slowly but also take longer to eliminate the breakdown products—known as metabolites—of those drugs. This delayed elimination is primarily due to decreased kidney and liver function, which can lead to the accumulation of metabolites in the bloodstream. For example, certain NSAIDs and opioids produce metabolites that can linger and cause extended or intensified side effects, such as prolonged sedation, confusion, or even toxicity.
In younger adults, these metabolites are usually cleared efficiently, but in seniors, they may reach higher concentrations and persist for days. This accumulation increases the risk of adverse reactions, especially when multiple medications are involved or when pain relievers are taken frequently.

Report lingering or unexplained symptoms (such as confusion or excessive sleepiness) to your doctor
Request periodic assessments of kidney and liver function if you use pain relievers regularly
Consider alternative therapies or lower doses to minimize buildup of drug metabolites

For more on medication metabolism and elimination in older adults, see this NIH review on drug metabolism in the elderly.

37. More Pronounced Hearing Changes

While hearing loss is a common part of aging, certain pain relievers can rarely accelerate or worsen this process, especially in older adults. High doses or prolonged use of NSAIDs such as ibuprofen and aspirin have been linked to an increased risk of hearing loss, possibly due to effects on blood flow or damage to the inner ear. According to the American Speech-Language-Hearing Association (ASHA), seniors are more susceptible to ototoxicity—the harmful impact of drugs on hearing—because their auditory system is already more fragile.
Signs of medication-related hearing changes can be subtle, such as ringing in the ears (tinnitus), muffled sounds, or trouble understanding speech in noisy environments. Since these symptoms may develop gradually, regular hearing screening is important for those who take pain relievers frequently or for long periods.

Schedule baseline and periodic hearing tests if you use NSAIDs or other ototoxic medications
Report new hearing changes to your provider promptly
Ask about alternative pain management options if you have a history of hearing loss

For more information on medication-induced hearing loss, see the ASHA’s guide to ototoxic medications.

38. Lowered Immune Response

Aging naturally reduces the effectiveness of the immune system, making older adults more susceptible to infections and slower to recover. Certain pain relievers—especially corticosteroids and high-dose NSAIDs—can further suppress immune function, compounding this vulnerability. These medications may decrease the body’s ability to mount a strong defense against bacteria and viruses or mask signs of infection such as fever and inflammation.
For example, long-term use of corticosteroids for pain or inflammatory conditions has been linked to higher rates of pneumonia and other serious infections in seniors. Similarly, frequent NSAID use may blunt the immune response, delay healing, or increase the risk of complications from minor illnesses. The Centers for Disease Control and Prevention (CDC) emphasizes that older adults taking immunosuppressive medications should be especially vigilant about infection prevention.

Practice good hand hygiene and avoid close contact with sick individuals
Stay current with recommended vaccines such as flu, pneumonia, and shingles
Report persistent or unusual symptoms—even if mild—to your healthcare provider

For more on immune suppression and infection risk in older adults, visit the CDC’s resources on infection prevention for seniors.

39. Higher Prevalence of Medication Non-Adherence

Older adults are much more likely to miss doses, take incorrect amounts, or stop pain relievers prematurely—a problem known as medication non-adherence. This can result from memory issues, complex dosing schedules, sensory loss, difficulty swallowing, side effects, or misunderstanding instructions. Financial barriers and a lack of social support may also contribute. Studies published by the National Institutes of Health reveal that nearly half of seniors do not take their medications as prescribed, which can undermine pain management and increase the risk of complications.
Solutions start with simplifying routines and improving communication. Pill organizers, medication reminder apps, and written schedules can help seniors keep track. Regular check-ins with healthcare providers or pharmacists ensure that instructions are clear and manageable. Involving family or caregivers may be necessary for those with significant cognitive or physical challenges.

Use clearly labeled pillboxes and set phone or clock reminders
Review medication lists regularly to eliminate unnecessary or duplicate prescriptions
Ask for help if vision, memory, or dexterity issues interfere with medication routines

For more tips on improving medication adherence in older adults, visit this NIH resource on medication management.

40. Diminished Sense of Thirst Increases Dehydration Risk

As people age, the body’s natural sense of thirst weakens, making it easier to become dehydrated without realizing it. Many pain relievers, particularly NSAIDs, can worsen this risk by affecting kidney function and fluid balance. Dehydration is especially dangerous for older adults because it can lead to confusion, low blood pressure, dizziness, and an increased risk of falls or kidney damage.
According to the National Institute on Aging, seniors should not rely on thirst as their cue to drink fluids. Instead, it’s important to develop conscious hydration habits and recognize early signs of dehydration, such as dry mouth, dark urine, or unexplained fatigue.

Drink water consistently throughout the day, even if you don’t feel thirsty
Limit caffeinated and alcoholic beverages, as they can increase fluid loss
Incorporate hydrating foods like fruits, soups, and yogurt into your meals

For more on staying hydrated and preventing dehydration, visit the NIA’s hydration guide for older adults.

41. Inconsistent Absorption Due to Gastric pH Changes

As we age, the acidity of the stomach often decreases—a condition known as hypochlorhydria. This change in gastric pH can significantly impact how pain relievers are absorbed, causing some medications to work less effectively or more unpredictably. For example, certain NSAIDs and acetaminophen require an acidic environment for optimal absorption, while others may become irritating if dissolved too quickly in a less acidic stomach.
This can lead to inconsistent pain relief or unexpected side effects, particularly if medications are taken on an empty stomach or with antacids. It’s important for older adults to be aware of these changes and adjust their medication routines accordingly.

Take pain relievers with food or a full glass of water unless otherwise directed
Avoid taking antacids close to medication time, as they may interfere with absorption
Consult your pharmacist or doctor about the best timing and form of medication for your needs

For more on how stomach acidity affects medication absorption, visit the NIH review on gastric pH and drug bioavailability.

42. Greater Likelihood of Hospitalization

Older adults are significantly more likely to be hospitalized due to complications from pain relievers than younger populations. According to the Centers for Disease Control and Prevention (CDC), adults aged 65 and older account for more than one-third of all hospital admissions related to adverse drug events, with pain relievers such as NSAIDs, acetaminophen, and opioids among the most frequent contributors. Common reasons for these hospitalizations include gastrointestinal bleeding, kidney injury, drug interactions, and overdose.
The consequences of hospital stays can be particularly severe for older adults, leading to a loss of independence, increased risk of infections, and longer recovery times.

Take all medications exactly as prescribed and do not adjust doses without medical advice
Attend regular check-ups to monitor for early signs of complications
Report any unusual symptoms—such as abdominal pain, confusion, or changes in urination—immediately to your healthcare provider

For more statistics and prevention strategies, visit the CDC’s medication safety and older adults resource.

43. Diminished Response to Emergency Treatments

Emergency treatments for pain reliever overdoses—such as naloxone for opioids or activated charcoal for certain poisonings—are often less effective in older adults. Age-related changes in organ function, slower circulation, and other chronic health conditions can delay or blunt the body’s ability to respond to these interventions. For example, the National Institutes of Health notes that older adults may require higher or repeated naloxone doses, and even then, reversal of overdose symptoms may be incomplete or temporary.
Additionally, delayed recognition of overdose symptoms and slower metabolism can mean that emergency treatments are administered later, further reducing their effectiveness. Seniors with frailty or multiple comorbidities are at greatest risk for poor outcomes after an overdose.

Ensure caregivers and family know the signs of overdose and how to act quickly
Keep emergency medications (like naloxone) accessible if you use opioids regularly
Discuss an emergency plan with your healthcare provider, especially if you are on high-risk medications

For more on emergency response in older adults, see this NIH review on opioid overdose management in seniors.

44. Difficulty Accessing Updated Medication Information

Older adults often face barriers to accessing the most current and accurate information about their medications. Changes in drug guidelines, new warnings, or emerging drug interactions may not be communicated clearly to seniors, especially those without internet access or who rely on outdated printed materials. Even when updates are available, medical jargon or small print can make it challenging to understand crucial changes. According to the CDC, this gap can lead to preventable medication errors and increase the risk of adverse reactions among older adults.
To stay informed, seniors and their caregivers should make use of trusted resources and maintain regular communication with healthcare professionals.

Ask your pharmacist about any updates or changes to your prescriptions at each refill
Request written information in large print or easy-to-understand language
Utilize reliable online resources such as the MedlinePlus Drug Information page or the FDA’s Drug Safety Communications

For further advice on accessing trustworthy medication information, visit the CDC’s medication safety page.

45. Greater Reliance on Caregivers

As people age, they often depend more on caregivers—whether family, friends, or professional aides—for medication management. Caregivers play a crucial role in ensuring pain relievers are taken correctly, monitoring for side effects, and communicating with healthcare providers. However, lapses in communication can introduce significant risks, including missed doses, duplicate medications, or unrecognized adverse effects. According to the Family Caregiver Alliance, nearly one in five medication errors in older adults involve breakdowns in communication between caregivers and medical professionals.
To reduce these risks, clear and consistent communication is essential. Caregivers should be included in medical appointments, maintain accurate medication lists, and have easy access to emergency instructions.

Keep a shared, up-to-date medication list that all caregivers can access
Set up regular check-ins with healthcare providers to discuss medication changes or concerns
Provide training for caregivers on recognizing side effects and proper medication administration

For more guidance on medication management for caregivers, visit the Family Caregiver Alliance’s medication management resource.

46. Age-Related Vision Loss Affects Dosing

Vision loss—due to conditions like cataracts, macular degeneration, or glaucoma—is common in older adults and can make reading medication labels, counting pills, and measuring liquid doses much more difficult. These challenges increase the risk of dosing errors with pain relievers, such as taking the wrong amount or mistaking one medication for another. The American Foundation for the Blind notes that such errors can lead to accidental overdoses, missed doses, or dangerous drug interactions.
To address these risks, adaptive solutions are available. Large-print labels, color-coded pillboxes, and talking prescription devices can help seniors manage their medications safely. Pharmacists can also provide easy-to-read instructions and help set up medication organizers.

Request large-print or braille labels from your pharmacy
Use pill organizers with tactile or audio features to distinguish between medications
Enlist help from caregivers or family for regular medication reviews and setup

For more adaptive strategies and resources, visit the VisionAware medication management guide.

47. Increased Risk of Dependency or Misuse

Older adults are at a heightened risk of developing dependency or unintentionally misusing pain relievers, particularly opioids and certain prescription medications. As tolerance builds over time, individuals may require higher doses to achieve the same level of pain relief, sometimes leading to overuse or addiction. Warning signs can be subtle in seniors—such as increased drowsiness, confusion, frequent requests for refills, or using pain medication for reasons other than pain.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), opioid misuse among older adults often goes undetected, in part because symptoms may be mistaken for normal aging or other health conditions.

Monitor for changes in mood, behavior, or medication-taking patterns
Keep pain relievers in a secure location and track usage carefully
Discuss non-drug pain management options such as physical therapy or mindfulness with your healthcare provider

For more on recognizing and preventing dependency or misuse, visit the SAMHSA resource on opioid misuse in older adults.

48. Changes in Nutritional Status Affect Drug Action

Malnutrition and vitamin deficiencies are common in older adults and can significantly affect how pain relievers work in the body. Poor nutrition may alter drug absorption, distribution, metabolism, and elimination, making medications either less effective or more toxic. For instance, low protein levels can change how drugs bind in the blood, increasing the amount of “free” drug and raising the risk of side effects. Deficiencies in vitamins like B12 or folate may also intensify certain medication-related nerve or cognitive problems.
According to the National Institutes of Health, addressing nutritional status is a critical aspect of safe medication use in seniors.

Include a variety of fruits, vegetables, lean proteins, and whole grains in daily meals
Ask your healthcare provider about screening for vitamin or mineral deficiencies
Consider working with a dietitian to optimize nutrition, especially if you have appetite or digestive issues

For more on how nutrition impacts medication safety, visit this NIH review on nutrition and pharmacology in older adults.

49. Reduced Social Support Increases Risk

Social isolation is a common challenge for many older adults, and it can significantly raise the risk of medication errors or unrecognized side effects from pain relievers. Without regular contact with friends, family, or caregivers, seniors are more likely to miss doses, take the wrong medication, or fail to notice subtle health changes that require attention. According to the Centers for Disease Control and Prevention (CDC), loneliness and isolation are linked to poorer health outcomes, including medication mismanagement and delayed medical care.
Building and maintaining a strong support network is essential for safe medication use. Regular check-ins with family, friends, or community volunteers can help monitor for adverse effects, provide reminders, and offer emotional support. Community programs, senior centers, and faith-based groups also provide valuable opportunities for connection.

Schedule regular phone or video calls with loved ones to discuss health and medications
Join local support groups or senior activities to stay engaged and informed
Ask your healthcare provider about community resources for isolated seniors

For more on the importance of social support and ways to reduce isolation, visit the CDC’s guide on loneliness and health in older adults.

50. More Frequent Doctor Visits Needed for Monitoring

Regular medical check-ups are essential for older adults taking pain relievers, as age-related changes make complications and side effects more likely. Frequent doctor visits allow healthcare providers to monitor for early signs of organ damage, drug interactions, or adverse reactions and to adjust dosing as needed. According to the National Institute on Aging, medication regimens should be reviewed at every appointment, especially when multiple prescriptions are involved.
These visits also provide an opportunity to discuss non-drug approaches to pain management, report new symptoms, and ensure that all health concerns are addressed. Proactive monitoring can catch issues before they become serious, supporting both safety and quality of life.

Bring a complete list of all medications (including over-the-counter and supplements) to every appointment
Schedule routine lab tests to check liver and kidney function as recommended
Discuss any changes in symptoms or side effects with your healthcare provider promptly

For more on the importance of regular check-ups and medication reviews, visit the NIA’s medicines and older adults guide.

Conclusion

As we’ve seen, pain relievers can pose significant and unique risks for adults over 60 due to age-related changes in metabolism, organ function, and medication sensitivity. Complications such as liver and kidney damage, falls, drug interactions, and even hospitalization are far more common in this age group. Vigilance and proactive healthcare are essential.
To protect yourself or your loved ones, make regular appointments for health screenings, medication reviews, and open conversations with your healthcare team. Bringing a complete medication list and reporting any new symptoms can help prevent serious complications. For further reading, consult the National Institute on Aging’s medication safety guide.
With careful management and support, older adults can safely manage pain while preserving their health and independence.

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