Older adults are not one group. Some people in their seventies or eighties are independent, active and managing only a few medicines. Some younger people have frailty, falls, confusion, complex conditions or a long medicines list. Age can matter, but it should not be used as a shortcut for saying yes or no.
For an older patient, a medical cannabis assessment usually needs to look carefully at falls, dizziness, confusion, memory, sedating medicines, blood pressure, carers, home safety and follow-up. The aim is not to create a blanket exclusion. It is to make sure the prescriber sees the real risks before making a decision.
This guide is for UK patients and carers preparing for a safer conversation. It is not medical advice, it does not recommend a product, dose, route, clinic or pharmacy, and it does not replace a GP, pharmacist, geriatrician, pain team, neurologist, mental-health team or specialist prescriber. For wider context, see MCPH’s patient guide and THC side effects and impairment.
The short answer
Tell the clinic about any falls, near-falls, dizziness, blackouts, confusion, memory concerns, delirium history, sleepiness, mobility problems or carer support. Bring a complete medicines list and, where possible, your Summary Care Record from the GP surgery.
The prescriber may need to review:
- falls and balance history;
- blood pressure and dizziness on standing;
- confusion, memory, attention or previous delirium;
- sedating medicines, pain medicines, sleep medicines and alcohol use;
- anticoagulants, blood pressure medicines and heart medicines;
- kidney, liver, lung, heart or neurological conditions;
- carer involvement and who can notice side effects;
- driving, cooking, stairs, bathing, mobility aids and other practical safety points;
- how soon follow-up should happen after any prescribing decision.
The practical patient action is to bring the risk picture into the open. Suitability stays with the prescriber.
Falls, dizziness and balance
Falls can change an older person’s independence, confidence and health quickly. NHS falls guidance lists factors such as poor balance, muscle weakness, vision problems, long-term conditions and medicines as relevant to falls risk. Some medicines can also make dizziness, drowsiness or low blood pressure more likely.
Medical cannabis can cause side effects such as sleepiness, dizziness, changes in mood or perception, and impaired attention in some people. For a patient who already has falls risk, those effects need a proper review.
Tell the clinic if:
- you have fallen in the last year;
- you have nearly fallen or started holding furniture to move around;
- you feel dizzy when standing;
- you use a stick, frame, wheelchair or falls alarm;
- you have osteoporosis, previous fractures, Parkinson’s, neuropathy, stroke, MS, arthritis or other mobility issues;
- you live alone or have stairs, poor lighting or trip hazards at home.
This is not about blaming the patient. It is about reducing avoidable harm.
Confusion, cognition and mental alertness
Confusion is not a minor side effect for someone already at risk. A small change in attention, sleepiness, reaction time or memory can affect cooking, medicines, driving, finances, falls, hydration and personal care.
The clinic should know about:
- memory problems, mild cognitive impairment or dementia diagnosis;
- previous delirium during infection, hospital admission or medicine changes;
- hallucinations, paranoia, severe anxiety or unusual behaviour;
- sleep disruption, alcohol use or sedating medicines;
- family or carer concerns about recent changes.
This does not mean a person with memory problems is automatically excluded. It means consent, capacity, support, monitoring and side-effect recognition need careful thought. If a carer is involved, the patient should still be central wherever they can take part in the decision.
Medicines that can add to the risk
Many older adults take several medicines. That does not make medical cannabis impossible, but it makes the medicines list more important.
Include:
- opioids, gabapentinoids, benzodiazepines, sleeping tablets and sedating antihistamines;
- antidepressants, antipsychotics, epilepsy medicines and Parkinson’s medicines;
- blood pressure medicines, diuretics, heart medicines and anticoagulants;
- diabetes medicines and medicines that affect appetite or hydration;
- over-the-counter medicines, supplements, CBD, alcohol and non-prescribed cannabis.
NHS medical cannabis guidance says CBD and THC can affect how other medicines work. The safe response is pharmacist and prescriber review, not self-adjusting medicines. If a medicine already makes you sleepy, dizzy, confused or unsteady, say so plainly.
Carers, family and support
Carers and family can be useful in an assessment, especially where the patient wants support or finds it hard to spot side effects early. They may notice changes in sleep, appetite, mood, balance, confusion, anxiety, falls, medicine errors or daily function.
That support should not replace the patient’s voice. A good assessment keeps the older adult central, checks consent and capacity where relevant, and is clear about who to contact if things change.
Useful practical questions include:
- Who will notice if confusion, sleepiness or unsteadiness appears?
- Who manages medicines, deliveries and appointments?
- Is there a falls plan or emergency contact?
- Would the GP, pharmacist, carer, care home, family member or specialist team need to know about a new controlled medicine?
For care homes or supported living, medicine storage, administration records and staff responsibilities may need separate review.
Monitoring and follow-up
Older adults may need closer follow-up, especially after starting, stopping or changing any medicine. The review should look beyond symptom scores.
Follow-up may need to cover:
- falls, near-falls, dizziness and blood pressure concerns;
- confusion, memory, anxiety, hallucinations or mood changes;
- sleepiness, daytime alertness and reaction time;
- appetite, hydration, constipation and nausea;
- medicine changes since the last appointment;
- driving, work, caring duties and home safety;
- whether carers or family have noticed changes.
If new confusion, repeated falls, chest pain, severe breathlessness, fainting, symptoms of stroke, serious allergic reaction or a sudden major change in behaviour occurs, seek urgent medical advice. Call 999 for a life-threatening emergency.
Questions to ask the clinic
- How will you assess falls risk before making a decision?
- Which of my medicines might increase sleepiness, dizziness or confusion?
- Do you need my pharmacist, GP surgery or specialist team involved?
- How would a carer or family member report side effects?
- What changes would mean pausing or reviewing treatment urgently?
- How soon would follow-up happen after prescribing?
- How will you check whether benefits, side effects and daily function are being balanced?
The right answer may be different for a fit 78-year-old, a frail 61-year-old, a patient with dementia, and a patient with severe pain but strong support at home. That is why assessment matters.
Sources
- NHS: Medical cannabis
- NHS: Falls
- NHS: Low blood pressure
- NICE: Cannabis-based medicinal products, NG144
- NHS England: Cannabis-based products for medicinal use
- GMC: Information for doctors on cannabis-based products for medicinal use
- CQC: Cannabis-based medicinal products: what we look at when we register
- HRA: Falls-risk increasing drugs in older people hospitalised with a fall
- Buckinghamshire Healthcare NHS Trust: Medicines and falls risk in care homes
- GOV.UK: Drug driving law
