American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

By the American Geriatrics Society 2015 Beers Criteria Update Expert Panel

Disclosures

J Am Geriatr Soc. 2015;63(11):2227-2246. 

In This Article

Abstract and Introduction

Abstract

The 2015 American Geriatrics Society (AGS) Beers Criteria are presented. Like the 2012 AGS Beers Criteria, they include lists of potentially inappropriate medications to be avoided in older adults. New to the criteria are lists of select drugs that should be avoided or have their dose adjusted based on the individual's kidney function and select drug–drug interactions documented to be associated with harms in older adults. The specific aim was to have a 13-member interdisciplinary panel of experts in geriatric care and pharmacotherapy update the 2012 AGS Beers Criteria using a modified Delphi method to systematically review and grade the evidence and reach a consensus on each existing and new criterion. The process followed an evidence-based approach using Institute of Medicine standards. The 2015 AGS Beers Criteria are applicable to all older adults with the exclusion of those in palliative and hospice care. Careful application of the criteria by health professionals, consumers, payors, and health systems should lead to closer monitoring of drug use in older adults.

Introduction

The American Geriatrics Society (AGS) Beers Criteria for Potentially Inappropriate Medication (PIM) Use in Older Adults is an explicit list of PIMs best avoided in older adults in general and in those with certain diseases or syndromes, prescribed at reduced dosage or with caution or carefully monitored. Beers Criteria PIMs have been found to be associated with poor health outcomes, including confusion, falls, and mortality.[1,2] Avoiding PIMs in older adults is one strategy to decrease the risk of adverse events. Interventions using explicit criteria have been found to be an important component of strategies for reducing inappropriate medication usage.[3–5]

The AGS Beers Criteria for PIM Use in Older Adults are one of the most frequently consulted sources about the safety of prescribing medications for older adults. The AGS Beers Criteria are used widely in geriatric clinical care, education, and research and in development of quality indicators. In 2011, the AGS assumed the responsibility of updating and maintaining the Beers Criteria and, in 2012, released the first update of the criteria since 2003. The AGS has made a commitment to update the criteria regularly. The changes in the 2015 update are not as extensive as those of the previous update, but in addition to updating existing criteria, two major components have been added: 1) drugs for which dose adjustment is required based on kidney function and 2) drug–drug interactions. Neither of these new additions is intended to be comprehensive, because such lists would be too extensive. An interdisciplinary expert panel focused on those drugs and drug–drug interactions for which there is evidence in older adults that they are at risk of serious harm if the dose is not adjusted or the drug interaction is overlooked.

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