What is the Beers List and Its Purpose?
First published in 1991, the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, commonly known as the Beers List, is a guideline developed by the American Geriatrics Society (AGS). Its primary purpose is to help healthcare providers improve the safety and quality of prescribing medications for adults 65 years and older. By identifying medications that should generally be avoided or used with caution in this population, the list aims to reduce adverse drug events, improve patient outcomes, and guide discussions about medication management.
The Mechanisms Behind Anticholinergic Side Effects
To understand why anticholinergics are on the Beers List, one must grasp how they work and their effect on the aging body. These drugs block the action of acetylcholine, a neurotransmitter that plays a crucial role in many bodily functions, including muscle contraction, memory, and regulating involuntary actions. While this mechanism can be beneficial for treating certain conditions, it has unintended consequences, especially in the central nervous system, where it can cause significant issues.
Impact on the Central Nervous System
As people age, the number of acetylcholine receptors in the brain and the amount of acetylcholine produced naturally decrease. Anticholinergic drugs amplify this age-related decline, leading to a cascade of central nervous system effects:
- Cognitive Decline: By disrupting acetylcholine signaling, these drugs can worsen memory, attention, and executive function. This can mimic or exacerbate the symptoms of dementia.
- Delirium: Anticholinergic effects are a common cause of delirium, a state of acute confusion and altered awareness.
- Sedation and Drowsiness: The effect on the CNS can cause sedation, leading to daytime sleepiness and fatigue.
Increased Risk of Falls
Beyond cognitive issues, anticholinergics present a significant physical danger to older adults.
- Dizziness and Unsteadiness: The central nervous system effects can cause dizziness and a lack of coordination, impacting balance.
- Blurred Vision: Some anticholinergics cause blurred vision, which can impair depth perception and increase the risk of tripping or misjudging steps.
- Orthostatic Hypotension: The medication can cause a drop in blood pressure when standing, leading to lightheadedness and fainting.
Common Anticholinergic Medications on the Beers List
Many medications with anticholinergic properties are prescribed for common conditions. Some are obvious, but many are a surprise to patients. Here is a list of some of the most common types of drugs to watch for:
- Antihistamines: First-generation antihistamines, like diphenhydramine (Benadryl), are widely available and often used for sleep or allergies but have potent anticholinergic effects.
- Antidepressants: Older tricyclic antidepressants (TCAs), such as amitriptyline, have strong anticholinergic properties.
- Gastrointestinal Agents: Some older medications for treating stomach cramps and nausea fall into this category.
- Urological Agents: Certain drugs used to treat overactive bladder are known anticholinergics.
- Antipsychotics: Several older antipsychotic medications also have significant anticholinergic activity.
Comparison: Anticholinergics vs. Safer Alternatives
Healthcare providers have a crucial role in weighing the risks versus the benefits of prescribing these medications. For many conditions, safer, non-anticholinergic alternatives exist, and a patient-specific risk-benefit assessment is always necessary.
| Medication Type | Anticholinergic Example (Beers List) | Safer Alternative Example | Reason for Safer Alternative | Risks of Anticholinergic |
|---|---|---|---|---|
| Antihistamines | Diphenhydramine (Benadryl) | Loratadine (Claritin) | Non-sedating and less likely to cause cognitive impairment. | High risk of sedation, confusion, and falls. |
| Antidepressants | Amitriptyline (Elavil) | SSRIs (e.g., Sertraline) | Lower anticholinergic burden, fewer side effects on the CNS. | Can cause severe cognitive impairment, constipation, and urinary retention. |
| Overactive Bladder | Oxybutynin (Ditropan) | Mirabegron (Myrbetriq) | Non-anticholinergic, works through a different mechanism with fewer CNS risks. | High risk of confusion, dizziness, and dry mouth. |
| Gastrointestinal | Dicyclomine (Bentyl) | Antispasmodics with lower anticholinergic risk, lifestyle changes. | Reduced risk of constipation, confusion, and urinary issues. | Significant risk of delirium and reduced GI motility. |
The Role of Awareness and Communication
For seniors and their families, understanding the Beers List is a tool for proactive health management. It empowers them to have informed conversations with their doctors and pharmacists. When a prescription is written, particularly for an older adult, it is appropriate to ask if the medication is on the Beers List and if there are safer alternatives.
It is critical not to stop taking any prescribed medication without consulting a healthcare professional. Abruptly discontinuing certain drugs can have serious and even life-threatening consequences. Instead, use this knowledge to engage in a collaborative discussion with your care team about your medication regimen. For more information on deprescribing and medication management, an authoritative source like the American Geriatrics Society offers extensive resources and criteria on this topic.
Conclusion
The inclusion of anticholinergics on the Beers List is a crucial safety measure rooted in clear scientific evidence of their adverse effects on older adults. From cognitive impairment and delirium to an increased risk of falls, these medications can significantly compromise the well-being of a vulnerable population. By raising awareness, fostering better communication between patients and providers, and exploring safer alternatives, it is possible to mitigate these risks and promote healthy aging through informed medication decisions. This understanding is a fundamental part of providing safe, high-quality senior care.
