American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

Potentially inappropriate medications (PIMs) continue to be prescribed and used as first-line treatment for the most vulnerable of older adults, despite evidence of poor outcomes from the use of PIMs in older adults. PIMs now form an integral part of policy and practice and are incorporated into several quality measures. The specific aim of this project was to update the previous Beers Criteria using a comprehensive, systematic review and grading of the evidence on drug-related problems and adverse drug events (ADEs) in older adults. This was accomplished through the support of The American Geriatrics Society (AGS) and the work of an interdisciplinary panel of 11 experts in geriatric care and pharmacotherapy who applied a modified Delphi method to the systematic review and grading to reach consensus on the updated 2012 AGS Beers Criteria. Fifty-three medications or medication classes encompass the final updated Criteria, which are divided into three categories: potentially inappropriate medications and classes to avoid in older adults, potentially inappropriate medications and classes to avoid in older adults with certain diseases and syndromes that the drugs listed can exacerbate, and finally medications to be used with caution in older adults. This update has much strength, including the use of an evidence-based approach using the Institute of Medicine standards and the development of a partnership to regularly update the Criteria. Thoughtful application of the Criteria will allow for (a) closer monitoring of drug use, (b) application of real-time e-prescribing and interventions to decrease ADEs in older adults, and (c) better patient outcomes.

[1]  J. Michel,et al.  Fighting Against Age Discrimination in Clinical Trials , 2010, Journal of the American Geriatrics Society.

[2]  P. Shekelle,et al.  The Development of Clinical Practice Guidelines and Guidance Statements of the American College of Physicians: Summary of Methods , 2010, Annals of Internal Medicine.

[3]  F. Lu,et al.  Use of the Beers Criteria to Predict Adverse Drug Reactions Among First‐Visit Elderly Outpatients , 2005, Pharmacotherapy.

[4]  Linda Gavendo,et al.  The incidence of adverse drug events in two large academic long-term care facilities. , 2005, The American journal of medicine.

[5]  R. McGlinchey,et al.  The anticholinergic risk scale and anticholinergic adverse effects in older persons. , 2008, Archives of internal medicine.

[6]  Improving medication use in gerontological nursing: now is the time for interdisciplinary collaboration and translation. , 2011, Journal of gerontological nursing.

[7]  M. Beers,et al.  Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. , 1997, Archives of internal medicine.

[8]  S. Kripalani,et al.  Inappropriate medications in elderly ICU survivors: where to intervene? , 2011, Archives of internal medicine.

[9]  K. Lapane,et al.  Alternatives to potentially inappropriate medications for use in e-prescribing software: triggers and treatment algorithms , 2011, Quality and Safety in Health Care.

[10]  Albert Figueras,et al.  Adverse Drug Reactions in an Elderly Hospitalised Population , 2005, Drugs & aging.

[11]  J. Guralnik,et al.  Patterns of functional decline at the end of life. , 2003, JAMA.

[12]  B. Craig,et al.  Incident use and outcomes associated with potentially inappropriate medication use in older adults. , 2010, The American journal of geriatric pharmacotherapy.

[13]  A. Lyles,et al.  Comparison of Prescribing Criteria to Evaluate the Appropriateness of Drug Treatment in Individuals Aged 65 and Older: A Systematic Review , 2011, Journal of the American Geriatrics Society.

[14]  R. Aparasu,et al.  Healthcare Outcomes Associated with Beers' Criteria: A Systematic Review , 2007, The Annals of pharmacotherapy.

[15]  C. Coltman,et al.  Underrepresentation of patients 65 years of age or older in cancer-treatment trials. , 1999, The New England journal of medicine.

[16]  B. Pollock,et al.  The Anticholinergic Drug Scale as a Measure of Drug‐Related Anticholinergic Burden: Associations With Serum Anticholinergic Activity , 2006, Journal of clinical pharmacology.

[17]  Lesley H Curtis,et al.  Inappropriate prescribing for elderly Americans in a large outpatient population. , 2004, Archives of internal medicine.

[18]  W. Applegate,et al.  Designing and Executing Randomized Clinical Trials Involving Elderly Persons , 1990, Journal of the American Geriatrics Society.

[19]  J. Avorn,et al.  Quality Indicators for Medication Use in Vulnerable Elders , 2007, Journal of the American Geriatrics Society.

[20]  M. Tinetti,et al.  Summary of the Updated American Geriatrics Society/british Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons , 2022 .

[21]  C. Sprung,et al.  Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock 2012 , 2013, Critical care medicine.

[22]  D. Garfinkel,et al.  Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy. , 2010, Archives of internal medicine.

[23]  L. Strausbaugh.  Emerging health care-associated infections in the geriatric population. , 2001, Emerging infectious diseases.

[24]  D B Reuben,et al.  Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine. , 1991, Archives of internal medicine.

[25]  P. Kaboli,et al.  Beers Criteria as a Proxy for Inappropriate Prescribing of Other Medications Among Older Adults , 2011, The Annals of pharmacotherapy.

[26]  Matthew Perri,et al.  Potentially Inappropriate Medication Use and Healthcare Expenditures in the US Community-Dwelling Elderly , 2007, Medical care.

[27]  K. Stockl,et al.  Clinical and economic outcomes associated with potentially inappropriate prescribing in the elderly. , 2010, The American journal of managed care.

[28]  M. Vitiello,et al.  Increasing Walking and Bright Light Exposure to Improve Sleep in Community‐Dwelling Persons with Alzheimer's Disease: Results of a Randomized, Controlled Trial , 2011, Journal of the American Geriatrics Society.

[29]  S. Inouye,et al.  Use of a Computer‐Based Reminder to Improve Sedative–Hypnotic Prescribing in Older Hospitalized Patients , 2007, Journal of the American Geriatrics Society.

[30]  M. Beers,et al.  Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. , 2003, Archives of internal medicine.

[31]  M. Boustani,et al.  Impact of anticholinergics on the aging brain: a review and practical application , 2008 .

[32]  M. Beers,et al.  Health outcomes associated with potentially inappropriate medication use in older adults. , 2008, Research in nursing & health.

[33]  D. Mehr,et al.  Clinical practice guideline for the evaluation of fever and infection in older adult residents of long-term care facilities: 2008 update by the Infectious Diseases Society of America. , 2009, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[34]  N. Picard,et al.  Is inappropriate medication use a major cause of adverse drug reactions in the elderly? , 2007, British journal of clinical pharmacology.

[35]  J. Hanlon,et al.  Association of adverse drug reactions with drug-drug and drug-disease interactions in frail older outpatients. , 2011, Age and ageing.

[36]  G. Guyatt,et al.  Grading quality of evidence and strength of recommendations , 2004, BMJ : British Medical Journal.

[37]  Elvy Ickowicz.  Pharmacological Management of Persistent Pain in Older Persons , 2009, Journal of the American Geriatrics Society.

[38]  R. Wallace,et al.  Inappropriate Medication Use as a Risk Factor for Self‐Reported Adverse Drug Effects in Older Adults , 2009, Journal of the American Geriatrics Society.

[39]  D. Bates,et al.  Incidence and preventability of adverse drug events among older persons in the ambulatory setting. , 2003, JAMA.