As people age, their physical and mental health can become more at risk for the side effects of certain medications. Healthcare providers must pay attention to Beers List criteria when prescribing drugs for the elderly; this criterion controls which medications are most likely associated with an increased incidence of adverse reactions in older patients. Not only that, but pharmacists must also review all other potential risks like drug-drug interactions or organ functions in their senior clients — ultimately ensuring these individuals receive the safest care possible.
In this blog post, we’ll discuss how a list like Beers Criteria helps identify potentially harmful drugs for seniors, as well as explore other valuable information about medication safety in the aging population so that everyone involved can be informed and proactive when it comes to caring for our elderly loved ones.
Table of Contents
What is the Beer List ?
In 1991, Dr. Mark Beers and his team published a paper to explain the creation of a consensus list of drugs deemed unsuitable for long-term care centers. This now well-known “Beers List” has been repeatedly updated since then. It is intended to be used by doctors in both outpatient and inpatient settings (except for hospice or palliative care) to improve the care of elderly people aged 65 and above. It highlights medications that should generally be avoided by all elderly, used with caution, or used very carefully in certain elderly patients.
What are the Beers Criteria?
As we age, our bodies change and metabolize medications differently. The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, or the Beers List for short, published by the American Geriatrics Society, serves as a guide for healthcare professionals to ensure the safe prescribing of medications for people 65 years and older.
With a focus on deprescribing unnecessary medications, the list aims to reduce the harmful effects of polypharmacy, drug interactions, and adverse drug reactions.
The Beers Criteria are used in geriatrics clinical care to monitor and improve the quality of care and for training, research, and healthcare policy purposes. They contain lists of medications that may have more risks than benefits for individuals aged 65 or older.
By using this criterion, clinicians can reduce the risk of adverse effects caused by such medications. The Beers Criteria is intended to guide healthcare practitioners, and it should not be used as an alternative to their professional judgment in prescribing decisions.
It can be used alongside other information to inform clinicians about safe practices when prescribing medicines for older adults.
The United States–originated criteria are often employed worldwide, although they were initially intended only for domestic applications. Several countries have adjusted the criteria to their needs, while others have noticed that certain medications listed in them may not be available in their country.
What are the Five Beers Criteria?
The American Geriatrics Society has put together the Beers Criteria to identify medications that may be inappropriate for adults over age 65. Its five categories are:
- Drugs to abstain from if you are over 65 and not in a hospice or palliative care setting.
- Substances to keep away from if you have specific health issues.
- Medications should be avoided due to the potential for drug interactions when taken with other meds.
- Drugs to avoid due to the harmful side effects that outweigh potential benefits.
- Medications are to be used in limited dosages or avoided altogether due to their effects on kidney function (renal impairment).
What Medications are on the Beers Criteria List?
The Beers Criteria list contains close to 100 medications or medication classes. This table provides a few examples of those drugs and why they can be harmful. It is not an exhaustive list.
| Beers Criteria Category | Drug or Drug Class Example | Concern |
| Analgesics | Meperidine | Neurotoxicity, delirium. |
| Antibiotics | Ciprofloxacin with warfarin | Increased bleeding. |
| Antiseizure medications | Carbamazepine | Syndrome of inappropriate antidiuretic hormone secretion (SIADH). |
| Antidepressants | Duloxetine | Nausea, diarrhea. |
| Antigout | Colchicine | Bone marrow toxicity. |
| Antihistamines | Brompheniramine | Confusion, cognitive impairment, delirium. |
| Antihypertensives | Alpha-blockers | Hypotension. |
| Antiplatelets or anticoagulants | Edoxaban | Renal impairment. |
| Antipsychotics | Any antipsychotics | Stroke, cognitive decline, delirium. |
| Anxiolytics | Benzodiazepines | Impaired metabolism, cognitive impairment, unsteady gait. |
| Cardiac medications | Disopyramide | Heart failure. |
| Central nervous system agents | Dimenhydrinate | Confusion, cognitive impairment, delirium. |
| Diabetes medications | Chlorpropamide | Hypoglycemia. |
| Gastrointestinal medications | H2-blocker for delirium | Worsening delirium. |
| Hormones | Estrogen | Breast cancer, endometrial cancer. |
| Hypnotics | Barbiturates | Dependence, overdose. |
| Musculoskeletal agents | Muscle relaxers | Confusion, dry mouth, constipation. |
| NSAIDs | Aspirin (more than 325 mg/day) | Ulcer, gastrointestinal bleeding or perforation. |
| Respiratory medications | Atropine | Confusion, cognitive impairment, delirium. |
| Urinary medications | Desmopressin | Low sodium in the blood (hyponatremia). |
| Vasodilators | Ergoloid mesylates | Lack of intended results. |
American Geriatrics Society 2024 updated AGS Beers Criteria
The major updates are the following key Points:
Key points
- The AGS Beers Criteria seeks to control and reduce older adults’ exposure to potentially inappropriate medications (PIMs) by enhancing medication selection, teaching healthcare professionals and patients, as well as being a tool for evaluating the quality of care, cost, and drug use among elderly individuals.
- In 2024 the AGS Beers Criteria is intended for healthcare consumers, practitioners, researchers, pharmacy benefit administrators, and regulators.
- The criteria apply to patients aged 65 and above in all ambulatory care (inpatient and outpatient), except when end-of-life or hospice care settings are involved.
FAQs:
How often are the Beers Criteria updated?
The American Geriatrics Society reviews and publishes the Beers Criteria list every three years.
How does the American Geriatrics Society update the Beers Criteria?
The American Geriatrics Society (AGS) updates the Beers Criteria list according to recently published medical evidence. An expert panel examines clinical trials and research studies to make revisions to the prior edition. The AGS panel will add, delete or modify medications on the list based on new evidence of their safety.
Final Words
The Beers Criteria is essential for healthcare providers when considering the potential risks of prescribing medications to older adults. It is necessary to stay up-to-date with the current list of potentially inappropriate drugs and understand how to adjust treatments according to the criteria. This will help ensure that older adults receive the best and safest treatments for their needs.
The American Geriatrics Society is committed to providing healthcare providers with accurate, up-to-date information about the potential risks of prescribing medications to older adults. The AGS Beers Criteria is regularly updated every three years to ensure the safety of older patients. By following the latest guidelines, healthcare providers can feel confident prescribing the proper medications for their elderly patients.
References
https://en.wikipedia.org/wiki/Beers_criteria
https://www.americangeriatrics.org/media-center/news/older-people-medications-are-common-updated-ags-beers-criteriar-aims-make-sure
Mrs. Marie Brown has been a registered nurse for over 25 years. She began her nursing career at a Level I Trauma Center in downtown Chicago, Illinois. There she worked in the Emergency Department and on the Surgical Intensive Care Unit. After several years, she moved to the Midwest and continued her nursing career in a critical care setting. For the last 10 years of her nursing career, Mrs. Brown worked as a flight nurse with an air ambulance service. During this time, she cared for patients throughout the United States.