Why is it called the Beers list? Understanding the Beers Criteria for Senior Care

Medication errors and adverse drug events are significant risks for older adults, with studies showing they are a leading cause of harm in senior care. The need for a standardized tool to prevent such issues led to the creation of the Beers list, named after the pioneering geriatrician who developed it. Understanding why is it called the Beers list is key to appreciating its ongoing impact on patient safety.

Quick Summary

The Beers list is named after Dr. Mark H. Beers, the geriatrician and researcher who first developed the criteria. He created the framework in 1991 to identify potentially inappropriate medications for older adults, aiming to reduce the risk of adverse drug events and improve patient safety in senior care settings.

Key Points

• Named After Dr. Mark H. Beers: The criteria are called the Beers list after the geriatrician who first developed them in 1991 to address medication risks in older adults.

• Purpose is Patient Safety: The list's primary goal is to guide healthcare providers in avoiding potentially inappropriate medications (PIMs) in seniors, thereby reducing adverse drug events.

• Evolving, Evidence-Based Guide: The Beers Criteria are not static; they are regularly updated by an expert panel of the American Geriatrics Society to reflect new medical evidence.

• Impacts Clinical Decision-Making: The list serves as a critical tool for clinicians, prompting them to review and reconsider medication choices for elderly patients.

• Reduces Risk and Improves Outcomes: By reducing the use of high-risk drugs, the Beers list helps lower the incidence of falls, cognitive impairment, and hospitalizations, improving senior health.

• Goes Beyond a Simple List: While informally known as the Beers list, the official AGS Beers Criteria provides a sophisticated, multi-category framework for safer prescribing practices.

Who Was Dr. Mark H. Beers?

The story of the Beers list is inextricably linked to its namesake, Dr. Mark H. Beers (1954–2009). He was a distinguished geriatrician and researcher who dedicated his career to improving the health and safety of older adults. Dr. Beers recognized a critical gap in medical practice: many commonly prescribed medications posed significant risks for seniors due to the unique physiological changes associated with aging. He saw a need for a clear, evidence-based guide to help clinicians make safer prescribing decisions. His work at UCLA and later at the Merck Manual laid the groundwork for this essential tool.

The Birth of the Beers Criteria in 1991

In 1991, Dr. Beers and his colleagues published the first version of the criteria in the Archives of Internal Medicine. This initial publication was a landmark moment in geriatric medicine. It was the first comprehensive, expert-consensus-driven list of medications that should be avoided or used with caution in older adults. The criteria were not meant to be a rigid set of rules but rather a guideline to prompt careful consideration and professional judgment. Because Dr. Beers was the primary author and leader of the research, the criteria quickly became known informally as "the Beers list" within the medical community, a name that has stuck ever since.

The Evolution of the List

Since its first publication, the Beers list has not remained static. It has undergone several updates to reflect new medical evidence and changes in drug availability. Key milestones include:

• 1997 Update: Refined the criteria based on further research.
• 2003 Update: The first update developed by an external panel, published in the Journal of the American Geriatrics Society (JAGS), following a grant from the American Geriatrics Society (AGS).
• 2012 Update: A major revision that included a new classification system and new medications.
• Subsequent Updates: The AGS has continued to update the criteria regularly, with the most recent version reflecting the latest research and clinical consensus. This continued evolution ensures the list remains a relevant and powerful tool for medication safety.

The Purpose and Impact of the Beers Criteria

The primary purpose of the Beers list is to guide healthcare providers in minimizing the use of potentially inappropriate medications (PIMs) in older adults. PIMs are drugs that may carry a high risk of side effects, are less effective, or have safer alternatives for seniors. The impact has been profound:

• Reduced Adverse Drug Events (ADEs): By highlighting high-risk medications, the list helps prevent falls, cognitive impairment, and other serious ADEs common in older populations.
• Improved Patient Outcomes: Safer medication use leads to better overall health, quality of life, and reduced hospitalizations.
• Enhanced Clinical Decision-Making: The Beers list serves as a constant educational tool for doctors, pharmacists, and nurses, promoting safer prescribing practices.

How the Beers List is Used in Practice

1. Comprehensive Medication Review: Clinicians compare a patient's medication list against the Beers criteria during regular check-ups or hospital stays.
2. Informing Discussion: It provides a framework for discussions with patients and their families about the risks and benefits of certain medications.
3. Guiding Prescribing: Doctors use it to make initial prescribing decisions, choosing safer alternatives when possible.
4. Promoting Deprescribing: For patients already on PIMs, it can prompt a discussion about carefully and safely tapering or discontinuing the medication.

A Comparison of High-Risk Medications

Medication Class	Why It's Problematic for Seniors	Potential Adverse Effects
Sedative-Hypnotics	Increased sensitivity and slower drug metabolism.	Increased risk of falls, fractures, cognitive impairment.
Anticholinergics	Can cross the blood-brain barrier, causing CNS effects.	Confusion, sedation, dry mouth, constipation, urinary retention.
Non-steroidal Anti-inflammatory Drugs (NSAIDs)	Increased risk of gastrointestinal bleeding and kidney problems.	Gastrointestinal upset, kidney damage, increased blood pressure.
Certain Antidepressants	Sedative properties and anticholinergic effects.	Increased risk of falls, delirium, and sedation.
First-Generation Antihistamines	Strong anticholinergic and sedative properties.	Sedation, dizziness, and cognitive decline.

The Beers List Today and Its Future

Today, the Beers list, formally known as the AGS Beers Criteria®, remains the gold standard for guiding medication use in older adults in the United States and beyond. The list is continuously updated by an expert panel convened by the American Geriatrics Society (AGS). This ongoing, evidence-based process ensures its relevance and accuracy. The American Geriatrics Society website provides the latest information and updates on the criteria.

Conclusion: A Lasting Legacy for Senior Safety

So, why is it called the Beers list? The answer is simple: it is a tribute to the pioneering work of Dr. Mark H. Beers. His vision and commitment to improving geriatric care resulted in a tool that has profoundly impacted medication safety for older adults. From its humble beginnings as a research paper in 1991 to its current status as the respected AGS Beers Criteria, the list stands as a lasting legacy to Dr. Beers' dedication to preventing medication-related harm in the senior population. It represents not just a list of drugs to avoid, but a fundamental shift towards more thoughtful, patient-centered, and evidence-based geriatric medicine.

Frequently Asked Questions

What is the Beers list?

The Beers list, officially known as the AGS Beers Criteria, is a guideline for healthcare professionals outlining medications that are potentially inappropriate for use in older adults due to high risk and low benefit.

Why is it called the Beers list and not something else?

It is called the Beers list because it was originally developed and published in 1991 by a team of researchers led by Dr. Mark H. Beers. The name simply stuck in the medical community as a shorthand reference.

Does the Beers list mean all listed medications are forbidden for seniors?

No, the Beers list is a guideline, not a rigid prohibition. It flags medications that require careful consideration, and a physician may still decide to prescribe a listed drug if the benefits outweigh the risks for a specific patient.

Who updates the Beers criteria?

The American Geriatrics Society (AGS) convenes an expert panel of physicians and pharmacists to regularly review and update the Beers criteria, ensuring it stays current with the latest medical research.

How often is the Beers list updated?

The AGS generally updates the Beers criteria every few years. These updates are published in medical journals and made available through the AGS website to inform healthcare professionals.

What kind of medications are on the Beers list?

The list includes various medication classes, such as sedative-hypnotics, certain antidepressants, anticholinergics, and non-steroidal anti-inflammatory drugs (NSAIDs), among others, that are particularly risky for older adults.

How can I check if a medication is on the Beers list?

You can ask your doctor or pharmacist to review your medications against the latest AGS Beers Criteria. Healthcare professionals use this resource to ensure your medication regimen is as safe as possible.