Medicines often become a part of health and well-being as you grow older. If you have a complex condition, or more than one health condition, you may require many medicines every day. Older people are more likely to have adverse effects from their medicines. The Beers Criteria® is a database of medicines that informs healthcare providers about medicines that may be inappropriate for older people. In short, it is a tool to make medicine prescriptions safer for older people.
What Is the Beers Criteria?
Dr. Mark Beers first developed the Beers Criteria in 1991. The guidelines are now updated frequently by the American Geriatric Society and known as the AGS Beers Criteria. The Beers Criteria for potentially inappropriate medication has lists of medicines that may be hazardous under certain situations. There are five such lists:
- Avoided by most older people. These medicines have a high probability of causing side effects in older people. Some of them do not work as well in older people. If possible, your doctor will not prescribe the medicines on this list. Often, safer alternatives are available. People in hospice and palliative care settings can be prescribed these medicines, since they're monitored by healthcare staff.
- Avoided by older people with specific health conditions. Some conditions can be made worse by certain medicines. If you have constipation, for example, you should avoid opiates for pain management.
- Avoided in combination with other treatments because of the risk for harmful drug interactions. These drugs are appropriate for use by themselves but become dangerous when taken together by an older person. For example, older people taking opioids with benzodiazepines or gabapentinoids are at risk of severe depression of breathing.
- Used with caution because of the potential for harmful side effects. These medicines can also cause medicine-related problems but are not considered as dangerous as those in list 1. Though they're to be used with caution, they're often the best choice for some people. When these are prescribed, you and your doctor should be aware of the specific risks and carefully monitor progress.
- Dosed differently or avoided among people with reduced kidney function. The kidneys process and excrete certain medicines, making the medicines difficult for the body to remove. Digoxin and non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, for example, should be avoided if you have kidney disease.
The Beers Criteria describes the medicines as "potentially inappropriate." It is not a law, and medicines on the lists are not absolutely prohibited. Rather, the Beers Criteria serves as a guide to healthcare providers, meant to guide prescribers away from medicines that may be harmful or cause severe side effects. Medicines on the lists may be prescribed if your healthcare provider decides you need them and the risks in your particular case are low.
Why Is the Beers Criteria Important?
Medicines behave differently once you're older. Their absorption from the gut, effect on your body, and inactivation and disposal may all be affected.
Your liver and kidneys are the organs chiefly responsible for dealing with any drugs in your bloodstream. As you grow older, they don't work as efficiently. You may need lower doses or less frequent doses. Some medicines may not be appropriate for you, and your doctor may change them.
Taking treatment for more than one condition is another risky situation. As the number of medicines goes up, the risk of adverse reactions also increases. This is particularly so in older people. By using a tool like the Beers Criteria, your doctor can identify potential incidents and avoid them.
Overprescribing is the prescribing of medicines to patients when:
- They do not need or want them
- There is greater potential for harm than benefit
- The more harmful of two possible choices is prescribed
- The appropriate medicine for a condition is prescribed to a patient for whom it is unsuitable
- Changes in a health condition make a medicine inappropriate or unnecessary but it is still prescribed
Overprescribing is not the same as polypharmacy. Polypharmacy is increasingly common and often considered unavoidable. The number of medicines doesn't define overprescribing. Even a single medicine incorrectly prescribed is overprescribing.
This is the prescribing of multiple medicines. It is common in older people because they are likely to have more than one health condition. Polypharmacy carries significant dangers, especially if you're receiving treatment from more than one doctor.
Appropriate polypharmacy. You may have a complex condition that requires multiple medicines. Or you may have two or more conditions that together need many medicines to keep you well. If the medicines are all prescribed according to best evidence and care regarding safety, it is appropriate polypharmacy.
Problematic polypharmacy. This is the prescription of many medicines where the benefits are not clear.
Polypharmacy is dangerous. Taking multiple medicines is associated with higher risks of adverse effects, falls, disability, emergency room visits, and hospitalizations. It may be possible to avoid the dangers by doing the following:
- Have your doctor review your existing prescription when adding a medicine.
- Consider the new drug as a trial rather than a permanent part of your medication.
- Try and reduce the doses of medicines in consultation with your doctor.
- Ask your doctor if you can discontinue any medicines.
Misuse of Medicines
Misuse of medicines is an increasing problem. It consists of taking prescription medicines in a way or dosage not prescribed. Taking someone else's prescription and taking medicine to get high are both considered misuse of medicines.
The medicines commonly misused are:
Opioids. They're prescribed for severe pain but are habit-forming and prone to misuse.
Medicines for sleep disorders and anxiety. Hypnotics, sedatives, and tranquilizers are also likely to be misused.
Stimulants. These drugs are prescribed for attention deficit hyperactivity disorder (ADHD). People without ADHD misuse them to gain focus and energy.
Misuse of medicines can have serious results. Overdose deaths and emergency room visits have both increased recently. While you may not plan to willingly misuse a drug, addiction is dangerous and can happen to anyone. Always ask your doctor about the addiction potential of the medicines they're prescribing.
Keeping Yourself Safe
If you're over 65, you must be careful about medicine use. Your doctor will make every effort to prescribe only appropriate medicines and avoid combinations that have interaction hazards. But you can also take some steps to ensure you're safe.
- Review your medication with your primary healthcare provider at regular intervals. Discuss all your medicines, including those prescribed by specialists.
- If you're taking medicines for multiple conditions, be aware of the drug interaction risks. If you are on five or more medicines (a situation called polypharmacy), the risks of drug interactions are high.
- Look up your medicines for their safety in older people yourself. The American Geriatric Society's iGeriatrics app includes the Beers Criteria but is aimed at healthcare providers and requires a subscription. However, you can get the information from their patient-centered website, Health in Aging.
- Don't stop or change a medicine without discussing it with your doctor.
- Never use someone else's medicines.