Beers Criteria

What is the Beers Criteria?

The American Geriatrics Society Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults is a list of medication guidelines that help healthcare providers safely prescribe medications for adults over age 65.

Studies show that over 90% of adults over age 65 take at least one prescription medication, while more than 66% of the same group take more than three prescriptions a month. The Beers Criteria is a list of potentially harmful medications or medications with side effects that outweigh the benefit of taking the medication.

Beers Criteria is also known as the Beers list.

What are the five Beers criteria?

The American Geriatrics Society uses specific criteria to list potentially inappropriate medications for adults over age 65. The five sections of the Beers Criteria are:

1. Medications to avoid if you’re over 65 years old and not in a hospice or a palliative care setting.
2. Medications to avoid among people with certain health conditions.
3. Medications to avoid that cause drug interactions when combined with other medications.
4. Medications to avoid due to harmful side effects that outweigh the benefits.
5. Medications to use at limited doses or avoided due to their effects on kidney function (renal impairment).

What medications are on the Beers Criteria list?

There are close to 100 medications or medication classes on the Beers Criteria list. The following list isn’t comprehensive, but it gives an example of a drug in each category and the reason why it’s harmful:

• Analgesics (meperidine): Neurotoxicity, delirium.
• Antibiotics (ciprofloxacin with warfarin): Increased bleeding.
• Antiseizure medications (carbamazepine): Syndrome of inappropriate antidiuretic hormone secretion (SIADH).
• Antihistamines (brompheniramine): Confusion, cognitive impairment, delirium.
• Antihypertensives (alpha-blockers): Hypotension.
• Antiplatelets or anticoagulants (edoxaban): Renal impairment.
• Antipsychotics (any): Stroke, cognitive decline, delirium.
• Anxiolytics (benzodiazepines): Impaired metabolism, cognitive impairment, unsteady gait.
• Cardiac medications (disopyramide): Heart failure.
• Central nervous system agents (dimenhydrinate): Confusion, cognitive impairment, delirium.
• Diabetes medications (chlorpropamide): Hypoglycemia.
• Gastrointestinal medications (H2-blocker for delirium): Worsening delirium.
• Hormones (estrogen): Breast cancer, endometrial cancer.
• Hypnotics (barbiturates): Dependence, overdose.
• Musculoskeletal agents (muscle relaxers): Confusion, dry mouth, constipation.
• NSAIDs [aspirin (more than 325 mg/day)]: Ulcer, gastrointestinal bleeding or perforation.
• Respiratory medications (atropine): Confusion, cognitive impairment, delirium.
• Urinary medications (desmopressin): Low sodium in blood (hyponatremia).
• Vasodilators (ergoloid mesylates): Lack of intended results.

How often is the Beers Criteria updated?

The American Geriatrics Society reviews and publishes the Beers Criteria list every three years.

How does the American Geriatrics Society update the Beers Criteria?

The American Geriatrics Society (AGS) creates the Beers Criteria list by reviewing new medical evidence published since the last revision. A panel of experts looks at clinical trials and research studies to revise the last published list. During the review process, the AGS panel may add, remove or change medications on the list based on published evidence of the safety of each medication.

When do healthcare providers use the Beers Criteria?

The Beers Criteria is a very common tool that a healthcare provider will use if they’re treating and prescribing medication to a person who’s over age 65. A healthcare provider will review your complete medical history, health status and current list of medications or supplements you regularly take to determine if a new or prescribed medication is safe for you. Your provider may modify the medication, dosage or frequency if they determine that a medication could be harmful to you or conflict with other treatments.

What are the potential risks of using Beers Criteria?

The Beers Criteria focuses on a wide population to identify safety risks of prescription medications. Because of the range of data, it isn’t person-specific. The Beers Criteria doesn’t take into consideration a person’s general health, all underlying medical conditions or circumstances that may lead a healthcare provider to choose a specific medication. Because of this, the Beers Criteria is a tool that providers can use, but it isn’t something that makes decisions on behalf of a skilled and experienced healthcare provider.

For example, if a healthcare provider wants to use a potentially inappropriate medication on the Beers Criteria, they’ll take into account your health and well-being and the setting in which you’re receiving care. This helps them make an official decision on whether or not the medication is safe. In most cases, your healthcare provider will have options to choose another type of medication than one on the Beers Criteria. If your provider needs to use a medication on the Beers Criteria list, they’ll closely monitor you during your treatment to make sure you’re safe and there aren’t any side effects.

Why do medications work differently in older adults?

As humans age, our bodies change. This can affect how medications absorb into our bodies. Some examples include:

• It takes longer for your body to break down medications. A medication may stay in your system longer, so your healthcare provider will give you a lower dose of a medication for this reason.
• Treatment for one condition may affect another. Certain medications can change the way your body responds. This can influence how well other treatments work.
• Lifestyle changes. Your activity level and diet can influence how well certain medications work in your body. When you meet with a healthcare provider, discuss your daily routine, diet and exercise so they can find a treatment option that’s right for you.

Healthcare providers understand the intricacies of our bodies and how they change with time. If your healthcare provider prescribes medication to you, they’ll monitor how your body responds to the treatment to make sure it’s safe.

A note from Cleveland Clinic

The Beers Criteria is a list of medications that a healthcare provider may reference when prescribing medications to a person over age 65. This list can help a provider make a decision about safely prescribing medications. If you have questions about a medication you’re taking, talk to your healthcare provider for more information.