From the Guidelines
The Beers List identifies medications that may be potentially inappropriate for older adults due to increased risks of adverse effects, including anticholinergic medications, old antihistamines, muscle relaxants, NSAIDs, sulfonylureas, and opioids, among others, as outlined in the most recent evidence from 1. These medications can cause a range of adverse effects, including broad muscarinic receptor blockade, CNS impairment, delirium, slowed comprehension, and falls. The use of these medications in older adults can lead to increased morbidity, mortality, and decreased quality of life, as they experience physiological changes such as decreased renal and hepatic function, reduced drug clearance, and increased sensitivity to certain drug effects. Healthcare providers should avoid prescribing these medications to older adults when possible or use with caution at reduced doses and durations, as recommended by 1. For example, if a benzodiazepine is needed, use the lowest effective dose for the shortest duration, and consider alternatives such as non-pharmacological approaches for insomnia or anxiety, or safer medication options like SSRIs instead of tricyclic antidepressants. Regular medication reviews for older patients are essential to identify and discontinue potentially inappropriate medications, as emphasized by 1. Some key medications to avoid or use with caution in older adults include:
- Anticholinergic medications, such as oxybutynin
- Old antihistamines, such as diphenhydramine and hydroxyzine
- Muscle relaxants, such as cyclobenzaprine and metaxalone
- NSAIDs, such as indomethacin, naproxen, and ibuprofen
- Sulfonylureas, such as glyburide and glipizide
- Opioids, such as morphine, oxycodone, and codeine
- Benzodiazepines, such as diazepam and alprazolam
- Antipsychotics, such as chlorpromazine, haloperidol, quetiapine, risperidone, and olanzapine. It is crucial to consider the potential risks and benefits of each medication and to prioritize the safety and well-being of older adults, as highlighted by the most recent evidence from 1 and 1.
From the Research
Potentially Inappropriate Medications for Older Adults
The Beers List, also known as the Beers Criteria, identifies medications that are potentially inappropriate for older adults due to their potential to cause harm or adverse effects 2, 3. These medications can be categorized into several groups, including:
- Medications that should generally be avoided in older adults because they are ineffective or pose a high risk of adverse effects, and safer alternatives are available 3
- Medications that should be avoided in older adults with specific medical conditions 3
Examples of Potentially Inappropriate Medications
Some examples of potentially inappropriate medications for older adults include:
- Anticholinergic medications, such as those used to treat overactive bladder or urge incontinence 4, 5
- Antipsychotic medications, which can increase the risk of adverse effects such as falls, orthostatic hypotension, and delirium 6, 4
- Benzodiazepines and non-benzodiazepine receptor agonist hypnotics (Z drugs), which can increase the risk of falls, confusion, and other adverse effects 4
- Nitrofurantoin, an antibiotic that can increase the risk of adverse effects such as pulmonary toxicity and hepatotoxicity in older adults 5
- Alpha-1 blocker medications, which can increase the risk of adverse effects such as orthostatic hypotension and dizziness 5
Considerations for Prescribing Medications to Older Adults
When prescribing medications to older adults, clinicians should carefully consider the potential risks and benefits of each medication, taking into account the patient's medical history, functional status, and social conditions 2, 6, 5. The Beers Criteria can be a useful tool for identifying potentially inappropriate medications and avoiding adverse effects in older adults 2, 3, 5. However, clinicians should also consider the individual needs and circumstances of each patient, and involve patients in shared decision-making whenever possible 6.