A History of Safer Medication for Older Adults
Originally developed in 1991 by Mark Beers, MD, the Beers Criteria was created to identify potentially inappropriate medications (PIMs) for older adults in institutional settings. The AGS took over the maintenance in 2011, evolving it into a widely used resource for healthcare professionals across various care settings, excluding hospice and palliative care. As the body changes with age, the risks and benefits of certain medications shift, making a resource like the Beers Criteria essential for informed, patient-centered care. The criteria serve as a roadmap for prescribers to navigate complex drug regimens and mitigate risks like falls, cognitive impairment, and drug-drug interactions.
Clarifying the 2025 Update: The New Alternatives List
While the last major update to the core Beers Criteria list of inappropriate medications was in 2023, the year 2025 is marked by a crucial and complementary development: the release of the AGS Beers Criteria® Alternatives List in July. This new list addresses a long-standing need by providing evidence-based suggestions for alternative non-pharmacologic and pharmacologic treatments. The expert panel behind the 2025 Alternatives List specifically focused on common clinical scenarios where clinicians often face challenges, offering actionable alternatives to potentially harmful medications. This moves the conversation beyond simply 'what to avoid' and provides practical guidance on 'what to do instead,' representing a major step forward for senior care.
Core Categories of the Beers Criteria
The Beers Criteria is organized into several key categories to provide detailed guidance for a wide range of clinical situations. These categories help healthcare providers and patients understand specific risks associated with certain medications.
Medications to Avoid in Most Older Adults
This is the most well-known part of the criteria, listing medications that carry a high risk of adverse effects in older adults. For example, older antipsychotics and certain muscle relaxants are generally on this list due to a heightened risk of sedation, falls, and other serious side effects.
Medications to Use with Caution
This category includes medications where the benefits might outweigh the risks for some individuals, but use requires careful monitoring. Healthcare providers must perform a patient-specific risk-benefit assessment. Examples can include certain sodium-glucose cotransporter-2 (SGLT2) inhibitors, which require monitoring for urogenital infections and diabetic ketoacidosis.
Clinically Important Drug-Drug Interactions
As older adults often take multiple medications (a condition known as polypharmacy), the risk of harmful drug-drug interactions increases. The criteria highlight specific combinations to avoid, such as combining three or more central nervous system-acting medications, to reduce the risk of serious outcomes like falls and delirium.
Medications Based on Kidney Function
Since kidney function declines with age, many medications are filtered less efficiently, leading to higher drug concentrations and an increased risk of toxicity. This section provides guidance on which medications require dose adjustment or should be avoided entirely in patients with reduced kidney function.
Medications to Avoid in Specific Common Conditions
Some medications can worsen specific health conditions common in older adults. For instance, certain anti-inflammatory drugs might exacerbate heart failure, while some decongestants can worsen hypertension. This section guides prescribers in avoiding such medications when a patient has a particular condition.
The Crucial Role of the 2025 Alternatives List
The July 2025 Alternatives List is a direct response to the need for safer alternatives identified by the Beers Criteria. Instead of just stopping a potentially inappropriate medication, clinicians can now leverage a curated list of evidence-based options to replace it effectively. This is particularly important for conditions like insomnia or pain management, where lifestyle changes or safer alternatives can be used instead of medications with higher risk profiles.
For more detailed information on best practices and resources, clinicians, patients, and caregivers should refer to the official site of the American Geriatrics Society.
Comparing the Beers Criteria with the 2025 Alternatives List
| Feature | Beers Criteria | 2025 Alternatives List |
|---|---|---|
| Primary Purpose | Identify medications with a higher risk-to-benefit ratio for older adults (PIMs). | Provide safer, evidence-based alternatives to PIMs identified in the Beers Criteria. |
| Focus | Lists of medications to avoid, use with caution, or adjust based on conditions. | Curated lists of alternative pharmacologic and non-pharmacologic treatment strategies. |
| Application | A cautionary tool for prescribers to avoid potentially harmful drugs. | A proactive tool for prescribers to implement safer, effective treatments. |
| Content | Tables detailing medications categorized by risk level, interactions, etc. | Tables detailing specific, prioritized alternatives based on clinical scenarios. |
| Outcome | Minimizes exposure to harmful medications. | Promotes the use of safer alternatives and supports deprescribing. |
How to Use the Beers Criteria and Alternatives List
For patients and caregivers, understanding these resources means becoming an informed partner in healthcare. When discussing a new or existing medication, ask your provider if it is on the Beers Criteria list. For clinicians, the criteria should be used as a guideline, not a hard-and-fast rule, always prioritizing individualized, patient-centered care. The addition of the 2025 Alternatives List empowers these shared decisions by offering concrete, safe options to consider.
The Role of Deprescribing
Deprescribing, the process of safely and systematically reducing or discontinuing medication, is a key strategy for reducing adverse drug events in older adults. The Beers Criteria and the new Alternatives List provide powerful tools to facilitate this process, allowing healthcare teams and patients to work together to optimize a medication regimen, reduce polypharmacy, and improve overall quality of life.
Conclusion
What is the beer Criteria 2025? It's the year that marks a major shift in geriatric care—moving from merely identifying risky medications to actively providing safer alternatives. By understanding both the foundational Beers Criteria and the innovative 2025 Alternatives List, patients, caregivers, and healthcare providers can work collaboratively to ensure safer, more effective medication management for older adults, ultimately supporting healthier and more independent aging. The focus on deprescribing and patient-centered decision-making reinforces a commitment to improving health outcomes for seniors everywhere.
