The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, commonly called the Beers List, are guidelines published by the

American Geriatrics Society The American Geriatrics Society (AGS) is a non-profit professional society founded on June 11, 1942, for health care professionals practicing geriatric medicine. Among the founding physicians were Dr. Ignatz Leo Nascher, who coined the term "geri ...

(AGS) for healthcare professionals to help improve the safety of prescribing medications for adults 65 years and older in all except

palliative Palliative care (derived from the Latin root , or 'to cloak') is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses. Wit ...

settings. They emphasize

deprescribing Deprescribing is the planned and supervised process of intentionally stopping a medication or reducing its dose to improve the person's health or reduce the risk of adverse side effects. Deprescribing is usually done because the drug may be causin ...

medications that are unnecessary, which helps to reduce the problems of

polypharmacy Polypharmacy (polypragmasia) is the simultaneous use of multiple medicines by a patient for their conditions. Most commonly it is defined as regularly taking five or more medicines but definitions vary in where they draw the line for the minimum ...

drug interaction Drug interactions occur when a drug's mechanism of action is disturbed by the concomitant administration of substances such as foods, beverages, or other drugs. The cause is often the inhibition of the specific receptors available to the drug, ...

s, and

adverse drug reaction An adverse drug reaction (ADR) is a harmful, unintended result caused by taking medication. ADRs may occur following a single dose or prolonged administration of a drug or result from the combination of two or more drugs. The meaning of this term ...

s, thereby improving the

risk–benefit ratio A risk–benefit ratio (or benefit-risk ratio) is the ratio of the risk of an action to its potential benefits. Risk–benefit analysis (or benefit-risk analysis) is analysis that seeks to quantify the risk and benefits and hence their ratio. A ...

of medication regimens in at-risk people. The criteria are used in

geriatrics Geriatrics, or geriatric medicine, is a medical specialty focused on providing care for the unique health needs of older adults. The term ''geriatrics'' originates from the Greek language, Greek γέρων ''geron'' meaning "old man", and ιατ ...

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.. 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.

History

Geriatrician Mark H. Beers formulated the Beers Criteria through a consensus panel of experts using the

Delphi method } The Delphi method or Delphi technique ( ; also known as Estimate-Talk-Estimate or ETE) is a structured communication technique or method, originally developed as a systematic, interactive forecasting method which relies on a panel of experts. The ...

. The criteria were originally published in the ''

Archives of Internal Medicine ''JAMA Internal Medicine'' is a monthly peer-reviewed medical journal published by the American Medical Association. It was established in 1908 as the ''Archives of Internal Medicine'' and obtained its current title in 2013. It covers all aspects ...

'' in 1991 and updated in 1997, 2003, 2012, 2015, and most recently in January 2019. 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.

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 ''American Geriatrics Society 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 The National Academy of Medicine (NAM), formerly called the Institute of Medicine (IoM) until 2015, is an American nonprofit, non-governmental organization. The National Academy of Medicine is a part of the National Academies of Sciences, E ...

(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 In public relations and communication science, publics are groups of individual people, and the public (a.k.a. the general public) is the totality of such groupings. This is a different concept to the sociological concept of the ''Öffentlichkei ...

period that occurred in parallel to its standard invited external

peer review process Peer review is the evaluation of work by one or more people with similar competencies as the producers of the work ( peers). It functions as a form of self-regulation by qualified members of a profession within the relevant field. Peer review ...

. 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 Journal of the American Geriatrics Society is a peer-reviewed journal of the American Geriatrics Society The American Geriatrics Society (AGS) is a non-profit professional society founded on June 11, 1942, for health care professionals practi ...

''. In 2019, the Beers criteria was updated.

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 Diphenhydramine (DPH) is an antihistamine and sedative mainly used to treat allergies, insomnia, and symptoms of the common cold. It is also less commonly used for tremor in parkinsonism, and nausea. It is taken by mouth, injected into a vein ...

(Benadryl), a first-generation H1 antagonist with

anticholinergic Anticholinergics (anticholinergic agents) are substances that block the action of the neurotransmitter called acetylcholine (ACh) at synapses in the central and peripheral nervous system. These agents inhibit the parasympathetic nervous system ...

properties, which may increase

sedation Sedation is the reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical procedure or diagnostic procedure. Examples of drugs which can be used for sedation include isoflurane, diethyl ether, ...

and lead to

confusion In medicine, confusion is the quality or state of being bewildered or unclear. The term "acute mental confusion"

or falls.

History

Management of criteria

Style of the publication

References

Further reading