Nootropics and Older Adults: Many Medicines, Falls Risk and Kidney Function

First: talk to your care team

Do not stop or change a prescribed medicine on your own. The National Institute on Aging says not to stop any prescribed medications without consulting your health care provider first. [1] If memory changes are new, getting worse or worrying, see a clinician; many causes are treatable, including some medicines. See medicines, sleep, mood and memory. For poisoning or a suspected overdose, call 911 or, in the US, Poison Help at 1-800-222-1222. This page is information only, with no amounts or schedules.

The short answer

Older adults are the group most often asked to try "memory" products, and also the group with the most reasons for caution. NIA says no vitamin or supplement is recommended for preventing Alzheimer's or other forms of cognitive decline. [1] The sources we read also describe more medicines, slower clearance, higher fall risk and more interactions with age. Whether any product is appropriate is a decision for a clinician or pharmacist who can see the whole medicine list and recent kidney tests.

Evidence labels used here

"Official advice" is a statement from a health agency. "Review" means a published summary of studies. "Proper evidence not found" means we searched and found nothing usable, and we say where.

Many medicines, many interactions

1. Medicine load

   UnclearSource

   Older adults often have multiple medical conditions and may take many medicines, which puts them at additional risk for negative side effects. [2]

   NIA, US

2. What counts as polypharmacy

   UnclearMeta-analysis

   One review defines it as the simultaneous use of 5 or more drugs. [3]

   Review, 2023

3. Supplements in that picture

   UnclearMeta-analysis

   Inappropriate polypharmacy includes supplements lacking evidence-based indications and ones that interact with other medicines. [3]

   Review, 2023

4. Possible consequences

   UnclearMeta-analysis

   Adverse drug reactions, depression, disability, falls and frailty are listed. [3]

   Review, 2023

5. Effect on thinking

   UnclearSource

   Some medicines and combinations of medicines can cause confusion, memory loss, hallucinations and delusions in older adults. [1]

   NIA, US

6. Supplements can change medicines

   UnclearSource

   A supplement might make a prescribed medicine either weaker or stronger. [4]

   NIA, US

NIA advises talking to your doctor about all medicines you take, including those from other doctors, over-the-counter drugs, vitamins, supplements and herbal remedies. [2] NCCIH adds that supplements may interact with medications or pose risks with certain medical problems or surgery. [5] Bring every product, including caffeine pills and energy drinks, to appointments. The American Geriatrics Society publishes the Beers Criteria, an explicit list of medicines typically best avoided by older adults in most circumstances or in specific situations, and says it should support rather than replace shared clinical decision-making. [6] Beers is a list of medicines, not of supplements, so it does not tell you whether a given nootropic is suitable.

Ginkgo as an example

Ginkgo is often marketed for memory. NCCIH says supplementation with ginkgo extract did not reduce the risk of dementia in large studies of older adults. [7] It also says ginkgo may increase the risk of bleeding in people taking anticoagulants such as warfarin. [7] The most common side effects named are dizziness, gastrointestinal symptoms and headache. [7] See ginkgo for memory and bleeding cautions for details. Other herbs and ingredients are in herbal nootropics safety.

Falls risk

NIA says some medications can increase a person's risk of falling because they cause side effects such as dizziness or confusion, and that the more medications you take, the more likely you are to fall. [8] The sources we read do not test whether specific nootropic products change fall rates, so Proper evidence not found for that question. Ingredients with dizziness among their side effects, such as ginkgo, are worth mentioning to a clinician if balance is a concern. [7] NIA also says some older people feel the effects of alcohol more strongly without increasing the amount they drink. [9] Caffeine late in the day can keep you awake at night. [10] See sleep and memory changes with age.

Kidney function

Age-related changes can raise exposure to some medicines. One review of anticholinergic drugs lists a reduction in kidney function among age-related changes. [11] Another review lists reduced clearance of multiple medications with aging. [3] Proper evidence not found, in the pages we read (NIA, NCCIH, NHS, NIDDK and PubMed searches), for official guidance on how much of a specific nootropic is acceptable with reduced kidney function. In a review of kidney donors, authors recommended avoiding dietary supplements in that group while noting little data identifying true harm; that is a donor population, not older adults in general. [12] For specific nutrients see minerals, supplements and kidney disease and creatine, kidney questions and creatinine testing. A clinician with recent blood tests can say whether anything needs checking.

Surgery

Reviews note dietary supplements can alter bleeding risk and anesthesia and analgesic efficacy in the perioperative period. [12] Tell the surgical team about every supplement; see supplements before surgery.

Questions to bring to a clinician or pharmacist

• Does this product interact with anything I take, including blood thinners?
• Could it add to dizziness, confusion or sleep problems?
• Do my kidney or liver results change the answer?
• Is there anything else on my list that could be affecting memory?

More: older adults and natural remedy safety, multiple medicines and supplement burden, vitamins and supplements for older adults and quality testing and certifications.