Among the following analgesics, which is listed as potentially inappropriate for older adults due to risks such as delirium or falls?

• A. Tramadol
• B. Morphine
• C. Hydromorphone
• D. Ketorolac

Answer: (A)

Tramadol is listed as potentially inappropriate for older adults because it carries a higher risk of central nervous system adverse effects that can lead to delirium and falls. Its pharmacology includes both opioid activity and an active metabolite (O-desmethyltramadol) formed by CYP2D6. In older individuals, reduced renal function can allow this metabolite to accumulate, increasing sedation, confusion, and balance problems. It can also lower the seizure threshold and interact with other CNS depressants or antidepressants, further raising delirium risk. While other analgesics have their own safety concerns, tramadol is specifically flagged for delirium and fall risk in the Beers criteria, making it the best answer here.