Which proton pump inhibitor is listed as inappropriate for older adults due to risks such as C. diff infection, pneumonia, bone loss, and fractures?

• A. Esomeprazole
• B. Pantoprazole
• C. Dexlansoprazole
• D. Omeprazole

Answer: (C)

Long-term suppression of stomach acid with a proton pump inhibitor in older adults is viewed as potentially inappropriate because it raises risks of C. difficile infection, pneumonia, and bone-related issues like osteoporosis and fractures. Dexlansoprazole, as a proton pump inhibitor, carries these same risks when used chronically or without a clear, ongoing indication. The Beers Criteria emphasizes using the lowest effective dose for the shortest duration and re-evaluating need regularly, especially in the elderly, where the harm/benefit balance is less favorable. If acid suppression is still needed, consider the shortest- duration therapy, dose reduction, or stepping down to an alternative (such as an H2 blocker) and deprescribing when possible.