Beers Criteria

The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, commonly called the Beers List, is a guideline for healthcare professionals to help improve the safety of prescribing medications for older adults. It emphasizes deprescribing medication that is unnecessary health care, which reduces the problems of high risk–benefit ratio, polypharmacy, drug interactions, and adverse drug reactions.

The criteria are used in geriatrics clinical care to monitor and improve the quality of healthcare. The criteria are also used in clinical care, training, research, and healthcare policy to develop performance measures and document outcomes. The "Beers Criteria" contains lists of medications that pose potential risks outweighing potential benefits for people 65 and older. By considering this information during routine care, practitioners may prevent harmful side effects, including those that could be life-threatening and other "adverse drug events". As more people reach geriatric status, the delivery of safe and effective healthcare in this special population has become increasingly important.

The Beers Criteria is meant to serve as a guide for clinicians and is not a substitute for professional judgment in prescribing decisions for an individual patient. Evidence from both the recent Budnitz study, which addresses emergency hospitalizations for ADEs in older Americans, and the STOPP/START criteria (Screening Tool in Older Persons for Potentially Inappropriate Prescriptions and Screening Tool to Alert Doctors to the Right Treatment) should be used in a complementary manner with the Beers Criteria to guide clinicians about safe prescribing in older adults.

History

Mark H. Beers, MD, a geriatrician, first created the Beers Criteria in 1991, through a consensus panel of experts by using the Delphi method. The criteria were originally published in the Archives of Internal Medicine in 1991 and were updated in 1997, 2003, 2012 and 2015

Management of criteria

In 2011, the American Geriatrics Society (AGS) convened an 11-member multidisciplinary panel of experts in geriatric medicine, nursing, and pharmacotherapy to develop the 2012 American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.

The 2012 AGS Beers Criteria differ from previous editions in several ways. In addition to using a modified Delphi process for building consensus, the expert panel followed the evidence-based approach that AGS has used since it developed its first practice guideline on persistent pain in 1998. The Institute of Medicine (IOM) in its 2011 report, Clinical Practice Guidelines We Can Trust, recommended that all guideline developers complete a systematic review of the evidence. Following the recommendation of the IOM, AGS added a public comment period that occurred in parallel to its standard invited external peer review process. In a significant departure from previous versions of the criteria, each recommendation is rated for quality of both the evidence supporting the panel’s recommendations and the strength of their recommendations. It is important to note that because medically complex older adults are often excluded from clinical trials, there is a shortage of evidence focused on this specific population.

In another departure from the 2003 criteria, the 2012 AGS Beers Criteria identify and group medications that may be inappropriate for older adults into three different categories instead of just two, as previously. The first category includes medications that are potentially inappropriate for older people because they either pose high risks of adverse effects or appear to have limited effectiveness in older patients, and because there are alternatives to these medications. The second category includes medications that are potentially inappropriate for older people who have certain diseases or disorders because these drugs may exacerbate the specified health problems. The third category includes medications to be used with caution in older adults. While these medications may be associated with more risks than benefits in general, they may be the best choice for a particular individual if administered with caution. The addition of this third category is important because it emphasizes that medications need to be tailored to the unique needs of each patient.

The 2012 AGS Beers Criteria was released in February 2012 via publication in the early online edition of the Journal of the American Geriatrics Society (JAGS) and is available at www.americangeriatrics.org. The AGS is developing a process for periodic updates to the criteria.

Style of the publication

Drugs listed on the Beers List are categorized according to risks for bad outcomes. The tables include medications that have cautions, should be avoided, should be avoided with concomitant medical conditions, and are contraindicated and relatively contraindicated in the elderly population. An example of an included drug is diphenhydramine (Benadryl), a first generation H1 antagonist with anticholinergic properties, which may increase sedation and lead to confusion or falls.

Further reading

• Marcum, Zachary A.; Hanlon, Joseph T. Commentary on the New American Geriatric Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. American Journal of Geriatric Pharmacotherapy. 2012 (10): 151–159.
• Potentially Inappropriate Medications for the Elderly According to the Revised Beers Criteria
• American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults