What is the purpose of the Beers criteria in managing medications for older adults?

The Purpose of Beers Criteria in Managing Medications for Older Adults

The Beers criteria identify potentially inappropriate medications that have risks outweighing benefits in older adults, serving as a critical tool to reduce adverse drug events, hospitalizations, and mortality in the geriatric population.

What Are the Beers Criteria?

The Beers criteria are a comprehensive set of guidelines developed to identify medications that:

• Have potential risks that outweigh potential benefits in adults 65 years and older 1
• Provide a rating of severity for adverse outcomes 1
• Include a descriptive summary of prescribing information associated with each medication 1
• Are regularly updated through a rigorous evidence-based approach using a modified Delphi method 2

Key Components of the Beers Criteria

The criteria are organized into several important categories:

• Medications or medication classes to avoid in older adults 3
• Medications to avoid in older adults with specific diseases or conditions 3
• Medications to be used with caution in older adults 3
• Drug-drug interactions documented to cause harm in older adults 2
• Medications that should be avoided or dose-adjusted based on kidney function 2

Clinical Impact and Implementation

The Beers criteria have demonstrated significant clinical value:

• Studies show that 11-21% of older cancer patients have potentially inappropriate medications according to Beers criteria 1
• When implemented in clinical settings, medication reviews based on Beers criteria led to:
  • 53% of patients having alterations in medication regimens
  • 28% having potentially inappropriate medications discontinued 1
• Use of inappropriate medications has been associated with higher rates of hospitalization and early discontinuation of treatments 1

How to Use the Beers Criteria Effectively

The criteria should be applied as a "warning light" rather than an absolute prohibition 4:

1. Medication review at every visit to identify potentially inappropriate medications 1
2. Consider alternatives when Beers criteria medications are identified
3. Use clinical judgment when applying the criteria - there are situations where listed medications may be appropriate 4
4. Monitor closely when Beers criteria medications must be used
5. Educate patients about why certain medications appear on the criteria and when their use may be more or less problematic 4

Evolution of the Beers Criteria

The criteria have evolved significantly since their inception:

• Originally developed in 1991 1
• Updated versions released in 1997,2003,2012,2015, and 2019 1, 5
• The American Geriatrics Society (AGS) now maintains and updates the criteria regularly 3
• Each update incorporates new evidence and removes medications that are no longer sold, have low usage rates, or show limited evidence of harm 5

Common Pitfalls to Avoid

When using the Beers criteria, be aware of these potential pitfalls:

• Misinterpreting as absolute contraindications - The criteria are meant to support, not replace, clinical judgment 4
• Failing to consider individual patient context - The criteria may not apply to all patients, particularly those in palliative or hospice care 2
• Using outdated versions - Always refer to the most recent update for current recommendations 5
• Overlooking alternative assessment tools - Consider complementary tools like the Medication Appropriateness Index (MAI) or STOPP/START criteria 1

The Beers criteria represent a valuable clinical tool that, when properly applied, can significantly improve medication safety and reduce adverse outcomes in older adults.