What Drugs Should You Avoid In the Elderly: An Update on the Beers Criteria

Dr. Mark Beers

Should you always avoid the use of metaclopromide in the elderly (I still use it in some circumstances)?  What about scopolamine – avoid always or consider for some instances like motion sickness?   And what about Megace – yet another drug to always avoid?

According to the new draft guidelines for the new AGS Updated Beers Criteria the answer for these questions and for many other medications is a clear “avoid”.  Now is your chance though to both read these draft guidelines and to give your opinion before they are finalized (click here for the AGS site).

Why spend your time doing this?

It’s been two decades since the original Beers Criteria was published by the late Dr. Mark Beers. The original list comprised of drugs that were potentially inappropriate for elderly patients residing in nursing homes but have been subsequently revised to include elderly patients in all settings.

The drugs listed in the Beers Criteria have side effects that were thought to be far more harmful in elderly patients than any potential therapeutic benefit.   They have been used by health care providers to help guide prescribing, and educators like myself to teach what drugs to avoid in the elderly.  Importantly though, other entities like CMS, the National Committee on Quality Assurance (NCQA), and Pharmaceutical Quality Alliance (PQA) are all interested in using the criteria as part of their quality measures.

In 2011, AGS convened an expert panel that reviewed available evidence as a part of its process for revising these guidelines.  These updated criteria address three primary areas:

• Criteria for Potentially Inappropriate Medication Use in Older Persons: Independent of Diagnoses or Conditions 
• Criteria for Potentially Inappropriate Medication Use in Older Persons Due To Drug – Disease/ Syndrome Interaction 
• Criteria for Potentially Inappropriate Medication Use in Older Persons: Drugs to be used with caution

So now is the time to comment before these guidelines are potentially used as a quality measure for your own practice. The draft AGS Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults (AGS Beers Criteria) will be available on the America Geriatrics Society (AGS) website for public comment until 5:00pm ET on November, 28, 2011.

 by: Eric Widera