Updating the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

TLDR

Medication toxic effects and drug-related problems can have profound medical and safety consequences for older adults and economically affect the health care system. The initiative aimed to revise and update the Beers criteria for potentially inappropriate medication use in adults aged 65 and older in the United States. Using a modified Delphi method, experts reviewed two categories of statements—medications generally to avoid in older adults and medications contraindicated with specific conditions—identifying 48 medication classes and 20 disease–medication pairs to be excluded. The panel identified 66 drugs with high‑severity adverse outcomes, confirming the criteria’s importance and highlighting that applying the updated Beers criteria can reduce drug‑related costs and problems.

Abstract

Medication toxic effects and drug-related problems can have profound medical and safety consequences for older adults and economically affect the health care system. The purpose of this initiative was to revise and update the Beers criteria for potentially inappropriate medication use in adults 65 years and older in the United States.This study used a modified Delphi method, a set of procedures and methods for formulating a group judgment for a subject matter in which precise information is lacking. The criteria reviewed covered 2 types of statements: (1) medications or medication classes that should generally be avoided in persons 65 years or older because they are either ineffective or they pose unnecessarily high risk for older persons and a safer alternative is available and (2) medications that should not be used in older persons known to have specific medical conditions.This study identified 48 individual medications or classes of medications to avoid in older adults and their potential concerns and 20 diseases/conditions and medications to be avoided in older adults with these conditions. Of these potentially inappropriate drugs, 66 were considered by the panel to have adverse outcomes of high severity.This study is an important update of previously established criteria that have been widely used and cited. The application of the Beers criteria and other tools for identifying potentially inappropriate medication use will continue to enable providers to plan interventions for decreasing both drug-related costs and overall costs and thus minimize drug-related problems.