American Geriatrics Society Updated Beers Criteria for Potentially

Inappropriate Medication Use in Older Adults

Meredith CookMercer COPHS

August, 2012

Beers CriteriaAGS and interdisciplinary panel of 11 experts

in geriatrics and pharmacotherapy53 medications or medication classesThree 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

Medications to be used in CAUTION in older adults

Beers CriteriaThis update will allow for:

Closer monitoring of medication useReal-time e-prescribing and interventions to

decrease adverse drug events in older adultsBetter patient outcomes

Medication Related ProblemsCommon, costly, and often preventable27% of ADE’s in primary care and 42% of

ADE’s in LTC were PREVENTABLE Most problems occurred at ordering and

monitoring stages of therapyTotal healthcare expenditures related to use

of PIMs was $7.2 billion in 2000/2001 Medical Expenditure Panel Survey

Medication Related ProblemsExplicit Criteria – unfavorable balance of risk

vs. benefit – consider alternate therapyImplicit Criteria – therapeutic duplication and

drug-drug interactions

Both of these have been taken into consideration when compiling the Beers List

PIMsLimited effectiveness in older adultsAssociated with serious problems, such as:

delirium, GI bleeding, falls, and fractures“Less is more” approachBeers List is now an important quality

measure with CMS, Medicare Part D, NCQA, HEDIS, and PQA

Potentially Inappropriate Medications and Classes to AVOID in Older Adults

New AdditionsMegestrolGlyburideSliding-scale insulin

Potentially Inappropriate Medications and Classes to Avoid in Older Adults with Certain Diseases and Syndromes

New AdditionsThiazolidinediones or Glitazones with CHFAcetylcholinesterase inhibitors with history of

syncopeSSRIs with falls and fractures

Medications to be used in CAUTION with older adults

New AdditionsAnti-thrombotics – caution in 75 years and

older

Removed Since 2003 (Last Update)

ConclusionsPreviously, ~40% of patient have received 1

or more drugs from this listNew update is based upon methods for

determining best-practice guidelinesThis list should serve as a guideline and risk

vs. benefit should always be assessedThis list is not meant to supersede clinical

judgment

ConclusionsPrescribing and managing disease states

should be individualizedIf a medication on the list cannot be avoided

and the physician feels it is necessary, the patient should be closely monitored for ADEs

Regular updates of this list allow for the evidence for medications to be assessed regularly, making it more relevant and sensitive to patient outcomes

ReferenceAmerican Geriatrics Society Updated Beers

Criteria for Potentially Inappropriate Medication Use in Older Adults. Journal of American Geriatric Society, 2012.