So the new Beers criteria have been released. As background, a geriatrician, Mark H. Beers, MD, sought to identify a list of medications back in 1991 that were generally considered inappropriate for use in seniors, primarily due to toxic adverse effects for this population. The original criteria were developed on the opinion of 13 nationally recognized experts and focused around nursing home residents. This 20-year-old approach has greatly influenced medication use in older people worldwide. The 1997 and 2003 updates were expanded to include older adults living in any setting.
The latest Beers Update, now sponsored and managed by the American Geriatrics Society (AGS), has had a significant shift in the methodology used to evaluate the body of clinical and scientific evidence on this topic. The AGS 2012 Beers Criteria Update Panel followed the 2011 Institute of Medicine’s Standards for Developing Trustworthy Practice Guidelines, in lieu of the previously used consensus process. This new process included rating the quality and strength of the evidence supporting the panel’s recommendations.
These criteria are valuable for practitioners taking care of older adults. They provide important information about medications but it is only a list of potentially inappropriate medications—there are circumstances in which a medication on the list is the only reasonable choice for a particular individual, because there is no alternative option and the potential benefit outweighs the risk.
There are fifty-three medications or medication classes in the final updated Beers list. Fourteen medications and classes are categorized as medications to be used with caution in older adults. A sample of several medications added to the 2012 Beers List:
- first- and second-generation antipsychotics
- sliding-scale insulin
- aspirin for primary prevention of cardiac events
- acetylcholinesterase inhibitors with a diagnosis of syncope
- caffeine in a patient with insomnia
- zolpidem in a patient with cognitive impairment
The new criteria, a downloadable pocket card, and several accompanying editorials are available from the American Geriatrics Society here.