Understanding the American Geriatrics Society (AGS) Beers Criteria
For decades, healthcare professionals have relied on the American Geriatrics Society (AGS) Beers Criteria as a foundational guideline to identify potentially inappropriate medications for older adults. This list, periodically updated, categorizes drugs with risks that often outweigh their benefits for those aged 65 and over. Physiological changes, such as decreased kidney function, reduced metabolism, and altered body composition, make older adults more susceptible to medication side effects. This heightened sensitivity means a drug that is relatively safe for a younger adult could be hazardous for an older person.
The AGS Beers Criteria groups medications into several categories, including drugs to avoid, drugs to use with caution, and drugs to be avoided in specific clinical situations. This detailed framework is a critical tool for minimizing medication-related harm, reducing hospital admissions, and improving overall quality of life for seniors.
Why are some medications so risky for seniors?
As we age, our bodies change in fundamental ways that affect how we process and react to medications. These changes can include:
- Decreased Renal Function: The kidneys' ability to filter drugs from the body diminishes, leading to higher drug concentrations that can increase toxicity.
- Altered Pharmacokinetics: Metabolism in the liver can slow down, causing some medications to remain in the body for longer periods.
- Increased Drug Sensitivity: The central nervous system and other organ systems can become more sensitive to medication effects, particularly those that cause sedation or confusion.
- Polypharmacy: The use of multiple medications simultaneously, a common practice among older adults, increases the risk of dangerous drug-drug interactions.
High-risk medication classes to be aware of
While consulting a healthcare provider is essential for personalized advice, several medication classes are consistently highlighted as high-risk in the geriatric population.
Benzodiazepines and Other Hypnotics
Benzodiazepines (e.g., diazepam, lorazepam) and non-benzodiazepine hypnotics (e.g., zolpidem) are used for anxiety and insomnia but are particularly dangerous for older adults. They can significantly increase the risk of:
- Cognitive impairment
- Delirium
- Motor vehicle accidents
- Falls and related fractures
Anticholinergic Medications
These drugs block the neurotransmitter acetylcholine, which is crucial for brain and muscle function. Many common over-the-counter and prescription drugs have anticholinergic effects, including certain antihistamines (e.g., diphenhydramine), tricyclic antidepressants (e.g., amitriptyline), and medications for urinary incontinence. Potential side effects include:
- Confusion and delirium
- Dry mouth and constipation
- Urinary retention
- Blurred vision
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
While commonly used for pain and inflammation, long-term or high-dose use of NSAIDs (e.g., indomethacin, ketorolac) can be hazardous for older adults. Risks associated with these medications include:
- Gastrointestinal bleeding and ulcers
- Kidney damage
- Increased blood pressure
- Worsening heart failure
Antipsychotics
Used for conditions like schizophrenia, some antipsychotics (especially first-generation agents) pose serious risks for older adults, particularly those with dementia. The FDA has issued a black box warning against their use for dementia-related behavioral problems due to an increased risk of death and stroke. Other potential harms include:
- Increased risk of stroke
- Cognitive decline
- Extrapyramidal symptoms (e.g., Parkinson-like movements)
Comparison of High-Risk Medication Classes in the Elderly
| Medication Class | Common Uses | Primary Risks for Seniors | Safer Alternatives |
|---|---|---|---|
| Benzodiazepines | Anxiety, Insomnia | Cognitive impairment, sedation, falls, fractures, delirium | CBT for insomnia, antidepressants for anxiety |
| Anticholinergics | Allergies, Urinary incontinence, Depression | Confusion, dry mouth, constipation, urinary retention | Second-generation antihistamines, non-medication interventions |
| NSAIDs | Pain, Inflammation | Gastrointestinal bleeding, kidney damage, increased blood pressure | Acetaminophen (within recommended dose), physical therapy |
| Antipsychotics | Schizophrenia, Bipolar disorder | Increased mortality (especially with dementia), stroke risk, sedation, movement disorders | Non-pharmacological interventions for dementia-related behaviors |
| Opioids | Moderate-to-severe pain | Sedation, constipation, cognitive impairment, increased fall risk | Non-opioid pain relievers, alternative therapies |
Promoting safer medication use
Taking medication safely is a team effort involving patients, caregivers, and healthcare providers. Key strategies for reducing risk include:
- Conduct a Medication Review: Regularly review all medications, including over-the-counter drugs, with a doctor or pharmacist. Ask if any are on the Beers Criteria list.
- Start Low and Go Slow: When starting a new medication, older adults should begin with the lowest possible dose and increase slowly, monitoring for side effects.
- Explore Non-Pharmacological Alternatives: For issues like insomnia or pain, consider lifestyle changes, physical therapy, or cognitive-behavioral therapy before turning to high-risk medications.
- Manage One Pharmacy: Using a single pharmacy helps ensure pharmacists can track all medications and identify potential drug interactions.
- Keep a Detailed List: Maintain an updated list of all medications, dosages, and prescribing doctors to share at every appointment. The FDA recommends keeping a digital or physical copy accessible at all times.
Navigating medication changes with your doctor
Making changes to a medication regimen, especially for long-standing prescriptions, should always be a collaborative process with your healthcare provider. Never stop taking a prescribed medication abruptly without medical guidance, as this can cause rebound effects or withdrawal symptoms. Instead, have an open conversation about the risks and benefits. Explain any side effects you may be experiencing and inquire about alternative, safer options.
For more detailed information on managing medications safely as you age, the National Institute on Aging provides comprehensive guidance. This resource can help you prepare for conversations with your healthcare team and advocate for your health needs.
Conclusion: Prioritizing safety in senior care
Safely managing medication is a cornerstone of healthy aging. While the question of which of the following classes of medication is considered high risk when used in the elderly population (> 65 years) has many answers, the central takeaway is that vigilance and communication are paramount. By understanding the risks associated with certain drug classes and working proactively with your healthcare team, older adults and their caregivers can significantly reduce the risk of adverse events. This empowers seniors to maintain their independence and well-being with greater confidence.
