{"id":29637,"date":"2021-04-27T10:59:38","date_gmt":"2021-04-27T14:59:38","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=29637"},"modified":"2022-10-04T15:33:26","modified_gmt":"2022-10-04T19:33:26","slug":"beers-criteria","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/beers-criteria\/","title":{"rendered":"What is the Beers Criteria? What seniors should know about their meds"},"content":{"rendered":"

It\u2019s a fact of life for most adults: The older you get, the more health conditions you acquire. Treating those health conditions often requires an arsenal of medications, all of which come with their own set of directions and potential side effects.<\/span>\u00a0<\/span><\/p>\n

It gets even <\/span>more <\/span><\/i>complicated when certain medications become less safe to take as you age, while others carry warnings about drug interactions. Aging can make some medication levels in your body get out of whack based on changes in the way your body processes them\u2014and can put you at increased risk for adverse events.<\/span><\/p>\n

Given the number of medications that many seniors take each day, it can feel daunting to keep track of what you\u2019re on and figure out if it\u2019s safe for you. Thankfully, the American Geriatrics Society (AGS)<\/span> maintains a list called the Beers Criteria<\/span><\/a>, an evidence-based collection of medications that seniors may want to avoid, or at least use with caution under the supervision of a health professional.<\/span><\/p>\n

\u00a0<\/span>Read on for more about what\u2019s included in the list and how you can use it to medicate safely.<\/span><\/p>\n

What is the Beers Criteria?<\/span>\u00a0<\/b><\/h2>\n

The Beers Criteria is a set of guidelines for clinicians to refer to when prescribing or recommending medications to seniors. It was adopted by the AGS in 2011 and<\/span> last updated in 2019<\/span><\/a>; the organization typically re-evaluates the criteria every three years.\u00a0<\/span><\/p>\n

The list includes all potentially inappropriate medications for older adults, generally defined as people over 65. There are<\/span> nearly 100 drugs on the list<\/span><\/a> as of 2019. The purpose of the AGS Beers Criteria is to ensure that all geriatric patients are prescribed safe and appropriate medications for their overall health, taking into consideration three main factors:<\/span><\/p>\n

1. Age<\/span>\u00a0<\/span><\/h3>\n

Older people with certain prior medical conditions should always be evaluated using the Beers Criteria, but the list applies to any adult over 65\u2014regardless of their health status.<\/span><\/p>\n

Why? Because our bodies\u2019 ability to metabolize some medications changes as we age, says Jeffrey Fudin, Pharm.D., owner and managing editor of<\/span> paindr.com<\/span><\/a>: \u201cSome drugs are cleared through the kidneys and the older you get, the worse your kidney function is.\u201d<\/span><\/p>\n

Some drugs are on the list because they can cause dangerous side effects in seniors. Blood pressure drugs, for example, may cause<\/span> orthostatic hypotension<\/span><\/a> (a sudden drop in blood pressure, usually when going from sitting or laying down to standing quickly). This may catch an older patient off guard, putting them at a higher risk of falling and seriously injuring themselves.<\/span><\/p>\n

2. Other medications<\/span>\u00a0<\/span><\/h3>\n

Drug interactions happen more often than you think, and your risk of taking a drug that interacts with another is higher if you\u2019re taking several different medications. This is known as<\/span> polypharmacy<\/span><\/a>, and it\u2019s very common in the elderly.<\/span><\/p>\n

\u201cOlder people are often prescribed multiple medications or [even given] inappropriate medications to manage their multiple chronic conditions,\u201d says <\/span>Scott Kaiser, MD<\/span><\/a>, director of geriatric cognitive health for the Pacific Neuroscience Institute at Providence Saint John\u2019s Health Center.<\/span><\/p>\n

Ideally, all of your medical information would be stored in one database so all of your healthcare providers could keep up-to-date with your current prescriptions. But this wouldn\u2019t solve every problem, says Dr. Kaiser, who warns that many people don\u2019t think to mention non-prescription drugs like over-the-counter (OTC) medications and supplements to their doctors.<\/span><\/p>\n

For example, <\/span>diphenhydramine<\/span><\/a>, or Benadryl, is included on the Beers Criteria for its<\/span> anticholinergic effects<\/span><\/a> on the nervous system, such as dizziness and confusion\u2014but it\u2019s an OTC drug, not a prescription one, and can be easily overlooked.<\/span><\/p>\n

\u00a0<\/span>\u201cIf someone gives you a list of all the meds they\u2019re taking but leaves out that they\u2019re taking something with diphenhydramine in it every night for sleep, you\u2019re missing out on a huge piece of the puzzle,\u201d Dr. Kaiser explains.<\/span><\/p>\n

3. Existing health conditions<\/span><\/h3>\n

The chances of having one or more medical conditions only goes up the older you get, but whether these are official diagnoses\u2014like<\/span> Type 2 diabetes<\/span><\/a> or <\/span>hypertension<\/span><\/a>\u2014or not, you may still be managing multiple symptoms across multiple conditions.<\/span><\/p>\n

\u201cYou might have symptomatic complaints like sleep issues, mental health concerns, or UTIs, and you might be [participating in] multiple medical solutions, including taking OTC drugs, going to your PCP, and seeing specialists,\u201d Dr. Kaiser says.<\/span><\/p>\n

Any complex health scenario leaves you vulnerable to ending up on a medication that\u2019s inappropriate for use because of your age or health status.\u00a0<\/span><\/p>\n

Which medications are on the Beers list?<\/span><\/h2>\n

Dr. Fudin finds it useful to group the medications in the Beers Criteria by pharmacology, or what the drugs are often used for. Classes of medications are grouped into broad categories including:\u00a0<\/span><\/p>\n

    \n
  1. Those that are potentially inappropriate in most older adults<\/span><\/li>\n
  2. Those that are potentially inappropriate in older adults with certain conditions<\/span><\/li>\n
  3. Those that should be used with caution<\/span><\/li>\n<\/ol>\n

    Each class of medication is assigned a strength of quality within that category based on a review of available literature: high, moderate, or low quality of evidence. Still, very few medications are outright contraindicated in all cases\u2014meaning there is almost always a benefit versus risk assessment needed.\u00a0<\/span><\/p>\n

    Quality of evidence<\/span><\/h3>\n

    Here are some of the major categories of drugs included on the list with\u00a0 moderate to high quality of evidence to place them on the Beers List:<\/span>\u00a0<\/span><\/p>\n\n\n\n\n\n\n\n\n\n\n
    Drug class<\/b><\/span><\/td>\nWhy it\u2019s on the list<\/b><\/span><\/td>\nSpecific drug names<\/b><\/span><\/td>\n<\/tr>\n
    First generation antihistamines<\/span><\/td>\nAnticholinergic; may cause dry mouth, constipation, dry eyes, dizziness, confusion<\/span><\/td>\nDiphenhydramine<\/span><\/a>,<\/span> doxylamine<\/span><\/a><\/td>\n<\/tr>\n
    Alpha blockers<\/span><\/td>\nMay cause sudden drops in blood pressure (orthostatic hypotension)<\/span><\/td>\nDoxazosin<\/span><\/a>, <\/span>terazosin<\/span><\/a><\/td>\n<\/tr>\n
    Tricyclic antidepressants<\/span><\/a><\/td>\nAnticholinergic; may be extremely sedating<\/span><\/td>\nAmitriptyline<\/span><\/a>, <\/span>nortriptyline<\/span><\/a><\/td>\n<\/tr>\n
    Barbiturates<\/span><\/a><\/td>\nHigher risk of dependence and overdose<\/span><\/td>\nButalbital<\/span><\/a>,<\/span> phenobarbital<\/span><\/a><\/td>\n<\/tr>\n
    Androgens<\/span><\/td>\nIncreased risk of heart problems<\/span><\/td>\nTestosterone<\/span><\/a><\/td>\n<\/tr>\n
    Benzodiazepines<\/span><\/a><\/td>\nIncreased risk of cognitive impairment and falls<\/span><\/td>\nLorazepam<\/span><\/a>,<\/span> diazepam<\/span><\/a><\/td>\n<\/tr>\n
    Proton-pump inhibitors<\/span><\/td>\nIncreased risk of infection, bone loss, and fractures<\/span><\/td>\nEsomeprazole<\/span><\/a>, <\/span>omeprazole<\/span><\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    Special Considerations<\/span><\/h3>\n

    Many medications included on the Beers list may be safe for use in some patients, but require physician\u2019s supervision; they may or may not be safe for you, depending on your other medications, existing conditions, or overall health. These include:<\/span>\u00a0<\/span><\/p>\n\n\n\n\n\n\n\n\n\n\n
    Drug class<\/b><\/span><\/td>\nWhy it\u2019s on the list<\/b><\/span><\/td>\nSpecific drug names<\/b><\/span><\/td>\n<\/tr>\n
    NSAIDs<\/span><\/a><\/td>\nIncreased risk of GI bleeds; may increase risk of kidney injury<\/span><\/td>\nIbuprofen<\/span><\/a>, <\/span>naproxen<\/span><\/a><\/td>\n<\/tr>\n
    Antipsychotics<\/span><\/td>\nMay increase symptoms of Parkinson\u2019s disease, increased risk of cognitive impairment and falls<\/span><\/td>\nClozapine<\/span><\/a>, <\/span>olanzapine<\/span><\/a><\/td>\n<\/tr>\n
    Oral decongestants<\/span><\/td>\nMay increase insomnia, blood pressure, or have other stimulating effects<\/span><\/td>\nPseudoephedrine<\/span><\/a>,<\/span> phenylephrine<\/span><\/a><\/td>\n<\/tr>\n
    Vasodilators<\/span><\/td>\nRisk of serious electrolyte abnormalities due to drug interactions<\/span><\/td>\nLisinopril<\/a>, Benazepril<\/a><\/span><\/td>\n<\/tr>\n
    Anticoagulants<\/span><\/a><\/td>\nRisk of several drug interaction resulting in increased risk of bleeding<\/span><\/td>\nWarfarin<\/span><\/a><\/td>\n<\/tr>\n
    Antiemetics<\/span><\/a><\/td>\nMay increase symptoms of Parkinson\u2019s disease<\/span><\/td>\nMetoclopramide<\/span><\/a><\/td>\n<\/tr>\n
    Anticonvulsants<\/span><\/td>\nMay increase risk of falls, fainting, loss of coordination<\/span><\/td>\nTopiramate<\/span><\/a>,<\/span> clonazepam<\/span><\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    This is not a full list of medications on the Beers list, which contains nearly 100 drugs; a complete listing of the drugs included in the 2019 update can be found<\/span><\/i> here<\/span><\/i><\/a>.<\/span><\/i><\/p>\n

    How to make sure your medications are safe<\/span>\u00a0<\/b><\/h2>\n

    If you\u2019re feeling overwhelmed by the thought of potentially inappropriate medication use or simply keeping track of everything you\u2019re prescribed, don\u2019t stress: There are several ways you can manage your complex medication needs without putting yourself at risk.\u00a0<\/span><\/p>\n

    1. Say \u201cyes\u201d to pharmacist counseling<\/span>\u00a0<\/span><\/h3>\n

    If you always dismiss the pharmacy\u2019s offer of medication counseling when you fill a new prescription, you\u2019re missing out on an opportunity to receive a free consultation about your medication usage.<\/span>\u00a0<\/span><\/p>\n

    \u201cYou should never ever refuse counseling,\u201d says Dr. Fudin. \u201cWhen you\u2019re handed a bag with instructions, it\u2019s important for you or your caregivers to understand what you\u2019re being given.\u201d<\/span><\/p>\n

    Not only could you be overlooking common issues or contraindications with that drug, you could be paying too much attention to things that happen only rarely and aren\u2019t a major concern. Your pharmacist can help you focus on the prescription information you actually need.\u00a0<\/span><\/p>\n

    2. Be proactive<\/span>\u00a0<\/span><\/h3>\n

    In a perfect world, you could count on every person on your medical team to know everything about each one of your medications. But the reality is that <\/span>you <\/span><\/i>need to be the captain of your ship: you need a reliable system to keep track of every medication or supplement you put in your body every day, says Dr. Kaiser, whether it\u2019s by maintaining an updated list in your smartphone or simply bringing all your pill bottles with you to your appointments.<\/span><\/p>\n

    \u00a0<\/span>And don\u2019t be afraid to get informed about the Beers Criteria yourself; although it was developed as a tool for clinicians, you may need to review it and call attention to any concerns you have.<\/span><\/p>\n

    \u201cIf you have multiple conditions, it\u2019s important to be the CEO of your own health,\u201d advises Dr. Kaiser. \u201cGet informed and educated, review your own list of medications, and use [that knowledge] to drive meaningful conversations with your healthcare team.\u201d<\/span><\/p>\n

    3. Re-evaluate your prescriptions regularly<\/span><\/h3>\n

    Just because you\u2019ve been taking a drug or dose for a long period of time doesn\u2019t mean it\u2019s still working for your now-older body. It\u2019s important, says Dr. Fudin, to renew your familiarity with the medications you\u2019re on by reading the pamphlet that comes with your prescription every three to four months.<\/span><\/p>\n

    \u00a0<\/span>\u201cLet\u2019s say you\u2019ve been on Ambien (zolpidem) for five years and you\u2019re used to taking it every night at bedtime\u2014but one of the things Ambien can cause is sleepwalking, and the older you get the more common that is,\u201d explains Dr. Fudin.<\/span><\/p>\n

    \u00a0<\/span>Not reading up on the side effects of a drug like<\/span> Ambien<\/span><\/a> could put you in a dangerous situation and you may not even realize the cause. A familiar drug could create different side effects now that you\u2019re older than it did when you first started taking it.<\/span><\/p>\n

    4. Notify your healthcare provider of changes<\/span>\u00a0<\/span><\/h3>\n

    Going on a new diet? Taking a new vitamin? Talk to your healthcare provider or pharmacist! Dr. Fudin says many natural products, like supplements, block or rev up the enzymes responsible for metabolizing certain drugs, so taking some supplements and medications together can increase side effects or make your medications less effective\u2014a very broad spectrum of potential problems.<\/span><\/p>\n

    There\u2019s also another reason to be cautious with supplements, Dr. Kaiser says: \u201cThere\u2019s less regulation and it can be unclear what\u2019s in there, plus we have a more limited understanding of how they could potentially interact with what you\u2019re taking as well as their potential adverse effects.\u201d\u00a0<\/span><\/p>\n

    5. Be open to communication<\/span><\/h3>\n

    As much as some people view the Beers Criteria as a list of drugs seniors should avoid, Dr. Kaiser says no drug on the list is truly off-limits. Instead, the list gives you and your physician the guidance to think about possible interactions or concerns and to talk through a risk versus benefit analysis of potential side effects.<\/span><\/p>\n

    Dr. Kaiser explains: \u201cThe Beers Criteria is an invitation for people to look at the meds they\u2019re on and ask questions: When was this prescribed, by whom, and why? What is its purpose, and is it having its intended effect?\u201d<\/span><\/p>\n

    The goal, in other words, is to assess a drug\u2019s appropriateness for you, personally\u2014the Beers Criteria is meant as a starting point for meaningful conversations with your healthcare provider, but it doesn\u2019t <\/span>replace <\/span><\/i>those conversations (or the expertise and experience of your medical team).<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

    It\u2019s a fact of life for most adults: The older you get, the more health conditions you acquire. Treating those health conditions often requires an arsenal of medications, all of which come with their own set of directions and potential side effects.\u00a0 It gets even more complicated when certain medications become less safe to take […]<\/p>\n","protected":false},"author":94,"featured_media":54352,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[8029],"tags":[8905,11278],"coauthors":[8860],"class_list":["post-29637","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-education","tag-seasonal","tag-singlecare-for-seniors","wpautop"],"acf":[],"yoast_head":"\nWhat is the Beers criteria? What seniors should know about their meds<\/title>\n<meta name=\"description\" content=\"The Beers Criteria are guidelines for physicians to keep older patients safe. 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