New Criteria Identify Commonly Prescribed Drugs that are Potentially Risky for Older Adults
A wide range of medications-some relatively new and others long available-can cause serious side effects and other adverse events in people 65 and older if not prescribed with care, according to the new American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. The criteria, last revised in 2003, appears today in the early online edition of the Journal of the American Geriatrics Society, and is available, with additional professional and public education materials, at www.americangeriatrics.org.
By identifying medications that are potentially harmful for older adults, the 2012 AGS Beers Criteria can help clinicians more safely prescribe for older patients. More than 40% of people aged 65 and older take five or more medications according to a 2008 study published in the Journal of the American Medical Association (JAMA) and each year more than a third of them will suffer a drug side effect or other adverse drug event (ADE). Estimates from studies published in JAMA (2003) and the American Journal of Medicine (2005) conclude that 27% of ADEs in primary care settings and 42% in long-term care facilities are preventable. A 2000-2001 Medical Expenditure Panel Survey estimates healthcare expenditures related to the use of potentially inappropriate medications at approximately $7.2 billion.
“Older adults run a particularly high risk of ADEs, in part because age-related physiological changes and multiple health problems can make them more vulnerable to such reactions,” says Jennie Chin Hansen, CEO of the American Geriatrics Society (AGS).
For example, a commonly used category of pain relievers known as non-steroidal anti-inflammatory drugs (NSAIDs) may worsen heart failure in those with this condition. Older adults are also at increased risk of ADEs because many take multiple medications, which can interact, causing potentially dangerous “drug-drug interactions.”
The late Mark H. Beers, MD, a geriatrician and editor of The Merck Manuals and The Merck Manual of Geriatrics, first published the Beers Criteria in 1991. In 2011, the AGS convened a panel of experts in geriatrics and pharmacotherapy to revise and expand the criteria, based on the latest research. The society plans to update the AGS Beers Criteria every three years.
Fifty-three medications and classes of medications are among those listed as potentially problematic in the 2012 AGS Beers Criteria, which group medications that may be harmful to older adults into three categories. The first category includes 34 medications that are potentially inappropriate because they either pose high risks of side effects or may have limited effectiveness in older adults, and because alternative treatments are available. New entries include “sliding scale insulin.”
The second category includes 14 medications that are potentially inappropriate for older people with certain diseases, risk factors, or disorders because they may exacerbate these conditions. Selective serotonin reuptake inhibitors, which may increase risks of falling in some older adults, are among the new entries in this category.
A third, new category added to the Beers Criteria includes 14 medications to be used with caution in older adults. These medications may be associated with more risks than benefits in older people in general, but nonetheless may be the best choice for a particular individual if administered with caution. Vasodilators are listed as they may increase episodes of syncope in older adults with a history of this condition, and contribute to greater risks of falling.
“These are drugs that studies suggest are potentially inappropriate for older people or should be used with caution in older adults with specific health problems. But responses to drugs vary significantly among older people. And, for some individuals, medications on these lists may be the best and only choice. The Beers Criteria alone should never dictate prescribing, nor should they be used punitively. They are intended to inform thoughtful prescribing decisions,” says Todd Semla, PharmD, MS, co-chair of the panel that the AGS convened to update and expand the criteria.
The Beers Criteria also influence research, the training of healthcare professionals, quality measures, and healthcare policy. The National Committee on Quality Assurance (NCQA) and the Pharmacy Quality Alliance (PQA) have used the Beers Criteria when developing key quality measures regarding pharmacotherapy and the Centers for Medicare and Medicaid Services (CMS) has incorporated the criteria into its evaluation of nursing home compliance with medication-related regulations.
The AGS has received funding from the John A. Hartford Foundation of New York and the Robert Wood Johnson Foundation to help support the development and dissemination of the criteria to the broadest possible audience of clinicians.