Annals of Long-Term Care: Clinical Care and Aging. 2015;23(10):11.
The majority of older people are prescribed multiple medications as part of their routine care, and geriatrics health professionals often find themselves dealing with two competing forces where medications are concerned. Tremendous innovation in medicine has contributed to increased longevity, but that same longevity is also changing how health experts approach safe prescribing. This is particularly true in long-term care contexts, where older adults could benefit from a medication review when transitioning from one care setting to the next, and where tools are needed to help practitioners with care planning on an ongoing basis. For those who grapple daily with the risks and benefits of medications for complex, chronic conditions, the updated American Geriatrics Society (AGS) Beers Criteria are a step toward greater clarity and more responsive care.
The AGS Beers Criteria are among the most frequently cited tools across geriatrics. They include specific (though not exhaustive) lists of medications that may be harmful to older adults who are not receiving hospice or palliative care. And now, under the direction of the AGS, they also reflect a unique interprofessional commitment to high-quality eldercare and to the development of tools, resources, and recommendations that can put geriatrics expertise in the hands of health professionals.
In addition to the long-standing list of potentially inappropriate medications, the 2015 suite of AGS Beers Criteria resources now includes the AGS’s first list of alternative therapies and non-pharmaceutical treatment options to consider instead of potentially inappropriate medications, as well as more detailed guidance on best practices for using the AGS Beers Criteria. Meant to be considered in tandem with the AGS Beers Criteria, the list of alternatives provides additional guidance for clinicians and the older adults they care for, who are prescribed medication more frequently than any other age group in the United States.
To develop these tools, the expert panel convened by the AGS reviewed more than 6700 clinical trials and research studies from a pool of more than 20,000 articles published since the last AGS update in 2012.
Among other highlights, the AGS Beers Criteria now include:
Separate guidance on avoiding 13 combinations of medications known to cause harmful “drug–drug interactions.” Treatments for several conditions common in older adults may be inappropriate when prescribed at the same time, because they can increase an older person’s risk for health problems like falls/fractures, urinary incontinence, and medication toxicity.
A specific list of prescriptions to avoid or adjust based on how well a person’s kidneys may be functioning. The 2015 AGS Beers Criteria list 20 potentially problematic medications for older people with moderate to severe kidney impairment, which could elevate risks for nausea and diarrhea, bleeding, problems with the central nervous system, and changes in mental status.
Three new medications and two new classes of medications added to warning lists for most older people or for those with specific health concerns. Noteworthy among these additions are proton-pump inhibitors that are often linked to an increased risk for bone loss, fractures, and serious bacterial infections.
Updates to remove several medications from the 2015 AGS Beers Criteria, either because they are no longer available or because the underlying condition or concern they address is no longer limited to older adults. For example, potentially inappropriate medications for those with chronic constipation were dropped from the 2015 AGS Beers Criteria, because constipation is common across the age spectrum and prescribing considerations are not specific to older adults.
Several modifications to existing recommendations on potentially inappropriate medications carried over from the 2012 AGS Beers Criteria. For example, with increasing evidence that antipsychotics cause considerable harm without improving outcomes for delirium and dementia, the 2015 AGS Beers Criteria now endorse “avoiding antipsychotics for behavioral problems” altogether unless behavior modification has failed or the older adult poses a physical threat to self or others.
AGS Beers Criteria tools—the lists of potentially inappropriate medications, the companion piece on potential alternative therapies, a guidance document on best practices for implementation, and several other materials for public education and professional development—will be available for free from GeriatricsCareOnline.org.