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Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

The American Geriatrics Society (AGS) 2019 Updated Beers Criteria—updated from 2015—are designed to reduce older adults' drug-related problems including, but not limited to, exposure to potentially inappropriate medications (PIM), drug-disease interactions, and medications that warrant extra caution in the older adult population. Older adults experience the highest prevalence of adverse drug events and many of these events are avoidable.

The new criteria include the same five main categories as in 2015: (1) PIM in older adults; (2) PIM to avoid in older adults with certain conditions; (3) medications to be used with considerable caution in older adults; (4) medication combinations that may lead to harmful interactions; and (5) a list of medications that should be avoided or dosed differently for those with poor renal function. Specific new changes in the 2019 update are described below:

  • Avoid the concurrent use of opioids with either benzodiazepines or gabapentinoids, due to the increased risk of overdose and severe sedation-related adverse events such as respiratory depression and death.
  • Use caution when prescribing trimethoprim-sulfamethoxazole in patients who are taking an angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor blocker (ARB), and who have decreased creatinine clearance, to avoid hyperkalemia.
  • H2-receptor antagonists may be used in patients with dementia, although they should be avoided in patients with delirium.
  • Use caution when recommending aspirin for primary prevention of cardiovascular disease or colorectal cancer in patients age 70 or older (down from previous threshold of 80 years or older), due to increased risk of bleeding.
  • Avoid the use of serotonin-norepinephrine reuptake inhibitors (SNRIs) in patients with a history of falls or fractures.
  • Avoid the use of sliding-scale insulin regimens (short- or rapid-acting insulin dosed according to current blood glucose levels) due to the risk of hypoglycemia without benefit of improvement in hyperglycemic management, unless patients are also on basal or long-acting insulin.

A summary of the Beers Criteria for patients is available free on the website of the AGS's Health in Aging Foundation (www.healthinaging.org/medications-older-adults/medications-older-adults-should-avoid), along with tip sheets in English and Spanish and what patients can do if they find that they are taking a medication on the list. The criteria list is not free to providers but can be accessed for a fee from the Journal of the American Geriatrics Society. It can also be accessed for a fee via the AGS iGeriatrics smartphone app.

References
  • ConsultGeri. Best practice information on care of older adults and best practices to guide non-pharmacologic intervention. consultgeri.org. Accessed July 15, 2019.
  • The 2019 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2019;67:674-694.

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Filed under: Health Policy and Trends, Preventive Medicine

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