What is the main safety concern with OTC sleep aids containing diphenhydramine in older adults?

• A. Increased risk of confusion, sedation, and falls.
• B. No adverse effects in older adults.
• C. Significant improvement in cognitive function.
• D. Lower risk of sedation.

Answer: (C)

Diphenhydramine is a strong anticholinergic antihistamine. In older adults, the brain is more sensitive to anticholinergic effects, which can cause confusion and delirium, and the drug’s sedating action can impair coordination and balance. Taken together, these effects markedly raise the risk of daytime drowsiness, falls, and injuries, making this a major safety concern for sleep aids used by older adults. For that reason, older patients are advised to avoid OTC sleep aids that contain diphenhydramine and instead focus on nondrug sleep strategies or safer, non-anticholinergic alternatives.