The American Geriatrics Society (AGS) Beers Criteria is a guideline for prescribing medications to adults aged 65 and older. The latest updates, such as the 2023 edition, are based on extensive evidence review. The five main categories serve to reduce the risk of adverse drug reactions, which are more common in older adults due to age-related physiological changes. These criteria are a tool for clinical decision-making, not a rigid set of rules.
The Five Categories of the Beers Criteria
The AGS Beers Criteria divides medications into five distinct categories to guide healthcare providers.
Category 1: Medications Potentially Inappropriate for Most Older Adults
This category lists drugs that should generally be avoided in older adults due to a high risk of adverse effects, limited effectiveness, or the availability of safer alternatives. Examples include certain benzodiazepines, first-generation antihistamines, and some muscle relaxants, which can increase the risk of confusion, sedation, and falls.
Category 2: Medications Potentially Inappropriate for Older Adults with Specific Diseases or Syndromes
This section focuses on drug-disease interactions, highlighting medications that could worsen certain health conditions common in older adults. For instance, certain anticholinergic drugs can exacerbate delirium, and NSAIDs can worsen heart failure. Prescribers must consider a patient's entire health profile to avoid these interactions.
Category 3: Medications to be Used with Caution
These medications may be appropriate for some older adults but carry a higher risk of side effects that require close monitoring. For example, certain antidepressants might cause low sodium levels, and some anticoagulants increase bleeding risk, especially in older adults. The balance of risks and benefits should be carefully weighed for each patient.
Category 4: Potentially Inappropriate Drug-Drug Interactions
This category lists combinations of medications that can be harmful when taken together, particularly in older adults. A common example is the use of two or more medications with anticholinergic properties, which can increase the risk of cognitive decline, delirium, and falls. Clinicians must review a patient's full medication list to identify and prevent these dangerous interactions.
Category 5: Medications to be Avoided or Dose-Adjusted Based on Kidney Function
This category addresses the impact of age-related decline in kidney function on medication processing. Many drugs are cleared from the body by the kidneys, and impaired renal function can lead to drug accumulation and toxicity. The Beers Criteria provide guidance on adjusting dosages or avoiding certain medications, such as some direct oral anticoagulants, in patients with reduced kidney function.
Using the Beers Criteria for Patient-Centered Care
The Beers Criteria are a vital tool but are not meant to replace clinical judgment. Healthcare providers should use them as a starting point for discussion, considering each patient's individual needs, preferences, and overall health status. In situations like hospice or palliative care, the balance of risks and benefits changes, and medications on the list may be deemed appropriate.
The Impact and Evolution of the Beers Criteria
The Beers Criteria originated from work by Dr. Mark Beers in 1991 to address inappropriate prescribing in nursing homes. Since 2011, the American Geriatrics Society (AGS) has updated the criteria regularly based on new research, ensuring their continued relevance. The goal is to improve medication selection, minimize adverse drug events, and enhance the quality of care for older adults.
Comparison of Beers Criteria Categories
| Category | Description | Example | Risk in Older Adults |
|---|---|---|---|
| Category 1 | Potentially Inappropriate Medications (PIMs) in most older adults. | First-generation antihistamines (e.g., diphenhydramine) | Increased risk of confusion, sedation, and falls due to anticholinergic effects. |
| Category 2 | PIMs for specific diseases or syndromes. | NSAIDs in patients with heart failure. | Exacerbation of the underlying condition. |
| Category 3 | Medications to be used with caution. | Certain anticoagulants (e.g., rivaroxaban) | Increased risk of bleeding that must be carefully monitored. |
| Category 4 | Potentially inappropriate drug-drug interactions. | Multiple anticholinergic medications. | Synergistic increase in risk for cognitive decline and falls. |
| Category 5 | Medications requiring dose adjustment for renal function. | Some oral anticoagulants with poor kidney function. | Higher risk of bleeding due to drug accumulation. |
Conclusion
The Beers Criteria provide an evidence-based framework for improving medication safety for older adults by identifying potentially inappropriate drugs. By using these five categories, healthcare professionals can make more informed, personalized decisions that reduce the risk of adverse drug events and enhance patient outcomes. The criteria serve as a crucial guide, emphasizing that a tailored approach is always necessary, with the ultimate goal of maximizing benefit while minimizing harm.
