What is the Beers List?

Date:

June 15, 2023

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What is the Beers List?

The American Geriatrics Society (AGS) has released its latest update to one of geriatrics’ most frequently cited reference tools: The AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. With more than 90% of older people using at least one prescription and more than 66% using three or more in any given month, the AGS Beers Criteria® plays a vital role in helping health professionals, older adults, and caregivers work together to ensure medications are appropriate.

Since 2011, the AGS has been the steward of the criteria and has produced updates on a regular cycle. The AGS Beers Criteria® is an explicit list of PIMs (potentially inappropriate medications) that are typically best avoided by older adults in most circumstances or under specific situations, such as in certain diseases or conditions. For the 2023 update, an inter-professional expert panel reviewed the evidence published since the last update (2019) and based on a structured assessment process approved a number of important changes including the addition of new criteria, modification of existing criteria, and formatting changes to enhance usability. The criteria are intended to be applied to adults 65 years old and older in all ambulatory, acute, and institutionalized settings of care, except hospice and end-of-life care settings.

Published in it’s entirety in Journal of the American Geriatrics Society (JAGS), the AGS Beers Criteria® serves as a comprehensive list of medications that older people should potentially avoid or consider using with caution because they often present unnecessary risks for this population.

For the 2023 update, an expert panel reviewed more than 1,500 clinical trials and research studies published between 2017 and 2022. The resulting 2023 AGS Beers Criteria® include:

  • Over three dozen individual medications or medication classes to avoid for most older people.
  • 40+ medications or medication classes to use with caution or avoid when someone lives with certain diseases or conditions.

The AGS Beers Criteria® is also available as a mobile app and as a pocket reference card, both of which can be accessed via GeriatricsCareOnline.org. As with past updates, the AGS has also created a suite of public education materials that are available at HealthinAging.org.

  • The intention of the AGS Beers Criteria® is to:
    • reduce older adults’ exposure to potentially inappropriate medications (PIMs) by improving medication selection
    • educate clinicians and patients
    • serve as a tool for evaluating the quality of care, cost, and patterns of drug use in older adults
  • The target audience for the 2023 AGS Beers Criteria® is practicing clinicians and others who utilize the criteria including healthcare consumers, researchers, pharmacy benefits managers, regulators, and policymakers.
  • The criteria are intended to be applied to adults 65?years old and older in all ambulatory, acute, and institutionalized settings of care, except hospice and end-of-life care settings.

What are the five Beers criteria?

The American Geriatrics Society uses specific criteria to list potentially inappropriate medications for adults over age 65. The five sections of the Beers Criteria are:

  1. Medications to avoid if you’re over 65 years old and not in a hospice or a palliative care setting.
  2. Medications to avoid among people with certain health conditions.
  3. Medications to avoid that cause drug interactions when combined with other medications.
  4. Medications to avoid due to harmful side effects that outweigh the benefits.
  5. Medications to use at limited doses or avoided due to their effects on kidney function (renal impairment).

What medications are on the Beers Criteria list?

There are close to 100 medications or medication classes on the Beers Criteria list. The following table isn’t a comprehensive list of all of the medications listed. Rather, it gives an example of a drug in each category and the reason why it’s harmful.

Beers Criteria CategoryDrug or Drug Class ExampleConcern
AnalgesicsMeperidineNeurotoxicity, delirium.
AntibioticsCiprofloxacin with warfarinIncreased bleeding.
Antiseizure medicationsCarbamazepineSyndrome of inappropriate antidiuretic hormone secretion (SIADH).
AntidepressantsDuloxetineNauseadiarrhea.
AntigoutColchicineBone marrow toxicity.
AntihistaminesBrompheniramineConfusion, cognitive impairment, delirium.
AntihypertensivesAlpha-blockersHypotension.
Antiplatelets or anticoagulantsEdoxabanRenal impairment.
AntipsychoticsAny antipsychoticsStroke, cognitive decline, delirium.
AnxiolyticsBenzodiazepinesImpaired metabolism, cognitive impairment, unsteady gait.
Cardiac medicationsDisopyramideHeart failure.
Central nervous system agentsDimenhydrinateConfusion, cognitive impairment, delirium.
Diabetes medicationsChlorpropamideHypoglycemia.
Gastrointestinal medicationsH2-blocker for deliriumWorsening delirium.
HormonesEstrogenBreast cancerendometrial cancer.
HypnoticsBarbituratesDependence, overdose.
Musculoskeletal agentsMuscle relaxersConfusion, dry mouthconstipation.
NSAIDsAspirin (more than 325 mg/day)Ulcergastrointestinal bleeding or perforation.
Respiratory medicationsAtropineConfusion, cognitive impairment, delirium.
Urinary medicationsDesmopressinLow sodium in blood (hyponatremia).
VasodilatorsErgoloid mesylatesLack of intended results.

Although the AGS Beers Criteria® may be used internationally, it is specifically designed for use in the United States and there may be additional considerations for certain drugs in specific countries. Whenever and wherever used, the AGS Beers Criteria® should be applied thoughtfully and in a manner that supports, rather than replaces, shared clinical decision-making.

Sources: National Library of Medicine; The John A. Harford Foundation; the Cleveland Clinic


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