Beers criteria

The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, commonly called the Beers List,[1] are guidelines published by the American Geriatrics Society (AGS) for healthcare professionals to help improve the safety of prescribing medications for adults 65 years and older in all except palliative settings.[2][3] 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.[4]

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 judgment in prescribing decisions. The criteria may be used in conjunction with other information to guide clinicians about safe prescribing in older adults.[5][6].

The criteria are frequently used internationally although they were only intended for use in the United States. Some countries have adapted the criteria to their own context. Others countries have observed that the listed medications may not be applicable in their country.[7]

History

Geriatrician Mark H. "Duff" 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[8] and updated in 1997, 2003, 2012, 2015, and most recently in January 2019.[9][10][11]

The AGS has registered a trademark for the term "AGS Beers Criteria" and in 2018, it formed a commercial partnership to authorize the release of a software application applying its official criteria.[12][13]

Management of criteria

In 2011, the American Geriatrics Society (AGS) convened an eleven-member multidisciplinary panel of experts in geriatric medicine, nursing, and pharmacotherapy to develop the 2012 edition of the American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.[14]

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,[15] 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.[14] 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.[14]

In 2019, the Beers criteria was updated.[1][16]

Style of the publication

Drugs listed on the Beers List are categorized 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.

References
  1. "Beers Criteria Medication List". Duke Clinical Research Institute. Duke Health. Retrieved August 28, 2018.
  2. American Geriatrics Society Beers Criteria Update Expert Panel (2019-01-29). "American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults". Journal of the American Geriatrics Society. Wiley. 67 (4): 674–694. doi:10.1111/jgs.15767. ISSN 0002-8614. PMID 30693946. S2CID 59338182. The AGS Beers Criteria® is an explicit list of Potentially Inappropriate Medications (PIMs) that are typically best avoided by older adults in most circumstances or under specific situations, such as in certain diseases or conditions.
  3. Steinman, Michael A.; Beizer, Judith L.; DuBeau, Catherine E.; Laird, Rosemary D.; Lundebjerg, Nancy E.; Mulhausen, Paul (2015-10-08). "How to Use the American Geriatrics Society 2015 Beers Criteria-A Guide for Patients, Clinicians, Health Systems, and Payors". Journal of the American Geriatrics Society. Wiley. 63 (12): e1–e7. doi:10.1111/jgs.13701. ISSN 0002-8614. PMC 5325682. PMID 26446776.
  4. American Geriatrics Society (2012). "Identifying medications that older adults should avoid or use with caution: the 2012 American Geriatrics Society updated Beers criteria". New York: Foundation for Health in Aging.
  5. Budnitz, Daniel S.; Lovegrove, Maribeth C.; Shehab, Nadine; Richards, Chesley L. (24 November 2011). "Emergency Hospitalizations for Adverse Drug Events in Older Americans". N Engl J Med. 365 (21): 2002–12. doi:10.1056/NEJMsa1103053. PMID 22111719. S2CID 37983506.
  6. Hamilton, Hilary; Gallagher, Paul; Ryan, Cristin; Byrne, Stephen; O'Mahony, Denis (13 June 2011). "Potentially Inappropriate Medications Defined by STOPP Criteria and the Risk of Adverse Drug Events in Older Hospitalized Patients". Arch Intern Med. 171 (11): 1013–1019. doi:10.1001/archinternmed.2011.215. PMID 21670370.
  7. Lee, Georgie; Lim, Joy-Francesca; Page, Amy T.; Etherton-Beer, Christopher; Clifford, Rhonda; Wang, Kate (2022). "Applicability of explicit potentially inappropriate medication lists to the Australian context: A systematic review". Australasian Journal on Ageing. 41 (2): 200–221. doi:10.1111/ajag.13038. ISSN 1741-6612. PMID 35025135. S2CID 245941385.
  8. Fick, DM; Cooper, JW; Wade, WE; Waller, JL; Maclean, JR; Beers, MH (2003). "Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts". Archives of Internal Medicine. 163 (22): 2716–2724. doi:10.1001/archinte.163.22.2716. PMID 14662625.
  9. American Geriatrics Society 2015 Beers Criteria Update Expert Panel (2015). "American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults". J Am Geriatr Soc. 63 (11): 2227–46. doi:10.1111/jgs.13702. PMID 26446832. S2CID 38797655.
  10. Louden, Kathleen (9 June 2015). "Geriatrics Society Updates List of Inappropriate Drugs". Medscape.
  11. "For Older People, Medications Are Common; Updated AGS Beers Criteria Aims to Make Sure They're Appropriate, Too". American Geriatrics Society.
  12. "Newsletter of the American Geriatrics Society" (PDF). American Geriatrics Society. Vol. 49, no. 3. 2018.
  13. "CSIS Health Homepage". CSIS Health Corp.
  14. American Geriatrics Society 2012 Beers Criteria Update Expert Panel (April 2012). "American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults". Journal of the American Geriatrics Society. 60 (4): 616–631. doi:10.1111/j.1532-5415.2012.03923.x. PMC 3571677. PMID 22376048.
  15. "Clinical Practice Guidelines We Can Trust". Archived from the original on 22 July 2014.
  16. "American Geriatrics Society 2019 Updated AGS Beers Criteria®for Potentially Inappropriate Medication Use in Older Adults" (PDF). American Geriatrics Society Beers Criteria Update Expert Panel. Archived from the original (PDF) on 30 August 2020. Retrieved 27 September 2020.

Further reading
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