American Geriatrics Society Updates Medication Guidelines for Elderly

The updated Beers Criteria contain important information regarding medications that should be avoided or used with caution in elderly patients.

The American Geriatrics Society recently released expanded and updated its guidelines for medication use in the elderly, generally known as the “Beers Criteria.” More than 2 in 5 people older than 65 take at least 5 medications, and each year one-third suffers from deleterious side effects, such as disorientation, urinary incontinence, or fractures.

H. Edward Davidson, PharmD, MPH, editor-in-chief of The Consultant Pharmacist, the journal of the American Society of Consultant Pharmacists, and a partner at Insight Therapeutics LLC, hails the new criteria. “The new list includes 53 medications identified by a list of 11 experts in the field of geriatric pharmacotherapy,” he says. “The review of the literature, which followed the 2011 IOM Standards for Developing Trustworthy Clinical Practice Guidelines, was more robust than previous publications. This makes sense, based on the increasing scrutiny of guideline development. However, we are not sure it impacts the results or utility of this list. Although selected individuals may fare well on these medications, a large proportion will not.”

To review the guidelines, expert panel members looked at 2,000 research studies on medications prescribed for elders. The experts identified various inappropriate medications for the elderly and sorted them into 3 categories:

• 34 medications and classes of medication were classified as “potentially inappropriate” for elders in general. Drugs on this list should be avoided.
• 14 medications used for common health problems were deemed potentially inappropriate in some cases and should be avoided in older adults who have specific conditions or syndromes.
• 14 types of drugs that should be used with caution. If these drugs are the best choice, patients using them should be carefully monitored.

The criteria were last updated in 2003. Davidson sums up the new guideline’s importance as follows: “Providers caring for older adults owe it to themselves to know this list and the limitations in the care of the elderly. HIT (health information technology) systems have incorporated these criteria into CPOE (computerized physician order entry) and other screening tools (eg, Monitor-Rx), and we expect the same with this new list. All in all, this list remains one of the standard tools for reducing medication-related problems in older adults.”

The new criteria differ from the previous version in important ways: discontinued medications (farewell, propoxyphene!) were removed and new drugs have been added. Notable additions in various categories include

• thiazolidinediones or glitazones for elders with heart failure
• acetylcholinesterase inhibitors for elders with a history of syncope
• selective serotonin reuptake inhibitors (SSRIs) for patients who have a history of falls and fractures
• dabigatran and prasugrel in adults older than 75

Furthermore, the criteria now include additional information about medications for common geriatric conditions.

The criteria should never override professional judgment. As with all elderly care, clinicians must adapt treatment to the individual based on circumstances, needs, and patient preference. Additionally, the criteria are not all inclusive; for example, they do not cover individuals receiving hospice and palliative care. Pharmacists interested in improving their clinical skills in older patients should visit the website of the American Society of Consultant Pharmacists.

Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.