A guide for drugs to avoid in older adults.

by AGS Media Center January 31, 2019 https://www.americangeriatrics.org
Published on Jul 05, 2019

Approximately 10% to 30% of hospital visits in older adults can be attributed to Adverse Drug Reactions and they have been described as 1 of the top 5 greatest threats to the health of the elderly population. The AGS Beers List plays a large role in these ADRs. The Beers Criteria is a list of potentially inappropriate medications for elderly patients and is meant to be a guideline for identifying medications for which the risks may outweigh the benefits in older patients. The problem of inappropriate prescribing in elderly patients presents an excellent opportunity for hospital case manager and physician collaboration.

Back in January, The American Geriatrics Society (AGS) unveiled its latest update to one of geriatrics’ most frequently cited reference tools: The AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. With more than 90% of older people using at least one prescription and more than 66% using three or more in any given month,the Beers Criteria®—a compendium of medications potentially to avoid or consider with caution because they often present an unfavorable balance of benefits and harms for older people—plays a vital role in helping health professionals, older adults, and caregivers work together to ensure medications are appropriate.

Published in its entirety in the Journal of the American Geriatrics Society the AGS Beers Criteria® also includes a host of resources— from mobile apps to a pocket reference card—to help clinicians implement prescribing recommendations (available from GeriatricsCareOnline.org), as well as tools to aid older adults and caregivers in understanding what “potentially inappropriate” medications mean (available for free from HealthinAging.org).

The AGS Beers Criteria® includes lists of certain medications worth discussing with health professionals because they may not be the safest or most appropriate options for older adults. Though not an exhaustive catalogue of inappropriate treatments, the five lists included in the AGS Beers Criteria® describe particular medications with evidence suggesting they should be:

  1. Avoided by most older people (outside of hospice and palliative care settings);
  2. Avoided by older people with specific health conditions;
  3. Avoided in combination with other treatments because of the risk for harmful “drug-drug” interactions;
  4. Used with caution because of the potential for harmful side effects; or
  5. Dosed differently or avoided among people with reduced kidney function, which impacts how the body processes medicine.

First developed by Mark Beers, MD, and colleagues in 1991, these lists have been staples of care for nearly three decades. They were transitioned to the AGS—a nonprofit society of some 6,000 experts in care for older people—in 2011.

Companion tools released with the 2019 update also include an expanded editorial outlining the proper use of the AGS Beers Criteria®, particularly when it comes to two important priorities this tool helps shape: Safe prescribing practices at the bedside and the development of quality measures for evaluating health care.

“The AGS Beers Criteria® should never solely dictate how medications are prescribed, nor should it justify restricting health coverage. This tool works best as a starting point for a discussion—one guided by personal needs and priorities as we age,” added Michael Steinman, MD, a fellow co-chair of the AGS Beers Criteria® panel.

In support of this principle, the AGS Beers Criteria® panelists used their companion editorial (DOI: 10.111/jgs.15766) to reiterate that:

  • Potentially inappropriate medications are just that—potentially inappropriate. They merit special scrutiny but should not be misconstrued as universally unacceptable in all cases or for all people.
  • The caveats and rationales informing AGS Beers Criteria® recommendations are as important as the recommendations themselves. Appreciating these nuances can help healthcare professionals know why medications are included on the lists, and how approaches to prescribing can be adjusted accordingly.