Which medication is listed as potentially inappropriate for use in older adults?

• A. Metformin
• B. Insulin
• C. Levothyroxine
• D. Simvastatin

Answer: (B)

The key idea is that older adults are at higher risk for certain drug-related harms, and the Beers Criteria flags medications with a notable potential for causing adverse events in this population. Insulin stands out because it carries a substantial risk of hypoglycemia, and elderly patients often have factors that increase both the likelihood and the consequences of low blood sugar (such as irregular meals, cognitive impairment, reduced physiologic reserve, and multiple other medications that can interact). Hypoglycemia in older adults can lead to dizziness, confusion, falls, fractures, and hospitalization, and symptoms can be blunted or harder to recognize in this group. Because of these risks, insulin is considered potentially inappropriate for use in some older adults unless there is careful monitoring, clear safety plans, and appropriate support, which is why it’s highlighted as a cautionary choice. The other medications have their own considerations, but they are not as broadly flagged for inappropriate use in older adults as insulin is when hypoglycemia risk is a major concern.