Understanding the American Geriatrics Society (AGS) Beers Criteria®
For healthcare professionals, the process of prescribing medication for older adults presents unique challenges due to age-related changes in the body and the prevalence of polypharmacy (the use of multiple medications). As the population ages, the need for standardized, evidence-based tools to guide safe prescribing becomes more critical. This is where the American Geriatrics Society (AGS) Beers Criteria® becomes essential.
Origins and Purpose of the Beers Criteria
First developed in 1991 by Dr. Mark Beers, the criteria were created to identify potentially inappropriate medications (PIMs) for use in nursing home residents. The American Geriatrics Society has regularly updated and maintained these guidelines since 2011, incorporating the latest evidence to refine the recommendations for a wider population of older adults.
The primary purpose of the AGS Beers Criteria® is to minimize adverse drug events (ADEs), which are particularly common and hazardous in older adults. The criteria serve as a valuable tool for clinicians, nurses, and pharmacists to evaluate the appropriateness of a drug regimen, considering the patient's age, medical conditions, and other medications being taken.
The Five Categories of Potentially Inappropriate Medications
The AGS Beers Criteria® categorizes medications into five main areas to provide comprehensive guidance:
- Potentially Inappropriate Medications (PIMs) for Most Older Adults: This category lists medications that should be avoided entirely in most older patients, except in specific situations like hospice or palliative care. Examples include certain first-generation antihistamines like diphenhydramine (Benadryl) due to their strong anticholinergic effects.
- PIMs to Be Used with Caution: Some drugs have risks that may outweigh their benefits for certain older adults. These medications should be used with extreme care and close monitoring. A classic example is the use of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, which can increase the risk of gastrointestinal bleeding and kidney problems in older adults.
- Clinically Important Drug-Drug Interactions: This section highlights combinations of medications that can lead to significant and potentially dangerous interactions. For example, combining opioids with benzodiazepines can cause excessive sedation and an increased risk of respiratory depression.
- PIMs Based on Specific Medical Conditions: The criteria list certain medications that may exacerbate existing medical conditions. For example, NSAIDs should be avoided in older adults with heart failure due to their potential to worsen the condition.
- Medications That Should Be Dose-Adjusted Based on Renal Function: Age-related changes can affect how the body processes and eliminates drugs, especially through the kidneys. The Beers Criteria provides guidance on adjusting dosages for medications that are eliminated by the kidneys to prevent accumulation and toxicity.
Applying the Beers Criteria in Clinical Practice
The Beers Criteria is not a rigid set of rules but a guideline that complements clinical judgment. Healthcare providers must consider the unique circumstances of each patient. The recommendations emphasize a patient-centered approach, including factors such as the patient's health goals, preferences, and the potential benefits versus harms of a medication.
Tools like medication reconciliation, where a patient's entire list of medications (including over-the-counter drugs and supplements) is reviewed, are essential for implementing the Beers Criteria effectively. The process of deprescribing, or reducing or discontinuing a medication, is also a vital intervention that aligns with the principles of safe medication management for older adults.
A Comparative Look: Beers Criteria vs. Other Geriatric Tools
To better understand the place of the Beers Criteria in geriatric care, it's helpful to compare it with other tools designed to improve prescribing safety. The following table provides a quick overview:
| Feature | AGS Beers Criteria® | STOPP/START Criteria | Medication Appropriateness Index (MAI) |
|---|---|---|---|
| Focus | Lists medications to be avoided or used with caution in older adults. | STOPP (Screening Tool of Older Persons' Potentially Inappropriate Prescriptions) identifies PIMs; START (Screening Tool to Alert Doctors to Right Treatment) identifies omitted beneficial drugs. | Provides a scoring system to assess the appropriateness of a patient's entire medication regimen. |
| Methodology | Expert panel review of scientific literature, updated periodically. | Explicit criteria based on a list of specific medications and conditions. | Implicit criteria using a set of 10 questions to guide a clinician's judgment. |
| Application | Broadly used across outpatient, acute, and long-term care settings. | Effective for identifying specific prescribing errors, particularly in hospitalized patients. | Best suited for detailed, individual patient medication reviews. |
| Advantage | Widely recognized and regularly updated based on evidence. | Includes a list of medications that may be missing, addressing undertreatment. | Offers a more comprehensive, patient-specific qualitative assessment. |
Conclusion
The AGS Beers Criteria® remains a cornerstone of geriatric medication management, providing a vital, evidence-based guide for healthcare professionals. By identifying potentially inappropriate medications, it empowers clinicians to make safer prescribing decisions for older adults, thereby reducing adverse drug events and improving patient outcomes. However, it's crucial to remember that these guidelines are a tool, not a substitute for comprehensive, patient-centered clinical judgment. For more information on medication safety and healthy aging, visit reputable sources like the National Institute on Aging.
