What is the Beers Criteria?

Introduction

The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, commonly called the Beers List, are guidelines for healthcare professionals to help improve the safety of prescribing medications for older adults 65 years and older in all except palliative setting.

They emphasize deprescribing medications that are unnecessary, which helps to reduce the problems of polypharmacy, drug interactions, and adverse drug reactions, thereby improving the risk–benefit ratio of medication regimens in at-risk people.

The criteria are used in geriatrics clinical care to monitor and improve the quality of care. They are also used in training, research, and healthcare policy to assist in developing performance measures and document outcomes. These criteria include lists of medications in which the potential risks may be greater than the potential benefits for people 65 and older. By considering this information, practitioners may be able to reduce harmful side effects caused by such medications. The Beers Criteria are intended to serve as a guide for clinicians and not as a substitute for professional judgement in prescribing decisions. The criteria may be used in conjunction with other information to guide clinicians about safe prescribing in older adults.

Brief History

Geriatrician Mark H. Beers formulated the Beers Criteria through a consensus panel of experts using the Delphi method. The criteria were originally published in the Archives of Internal Medicine in 1991 and updated in 1997, 2003, 2012, 2015, and most recently in January 2019.

In 2018, the American Geriatrics Society (AGS) partnered with CSIS Health Corp to provide the first and only licensed software application of the Beers Criteria for use in Electronic Health Records, Population Health Management, and Care Management platforms.

Management of Criteria

In 2011, the AGS convened an eleven-member multidisciplinary panel of experts in geriatric medicine, nursing, and pharmacotherapy to develop the 2012 edition of the AGS 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.

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 the previous two. 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 that, although they may be associated with more risks than benefits in general, may be the best choice for a particular individual if administered with caution.

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.

The most recent update to the Beers criteria was completed in 2019.

Style of the Publication

Drugs listed on the Beers List are categorised according to risks for negative 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.

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