Beers Criteria Template

## **What are the Beers Criteria?** The Beers Criteria, established by the American Geriatrics Society (AGS), outlines potentially inappropriate medications (PIMs) for older adults. These criteria assist healthcare professionals in prescribing medications for older patients in most circumstances or under specific situations (2023 American Geriatrics Society Beers Criteria® Update Expert Panel, 2023), aiming to avoid potentially harmful effects and adverse drug-drug interactions.  The AGS Beers Criteria guides medication classes and specific drugs that may pose risks, particularly in older adults with certain diseases or health problems. It helps healthcare providers in clinical decision-making, emphasizing the importance of considering factors like renal function, reduced ejection fraction, and other relevant health issues. The American Geriatrics Society (AGS) revises this list every three years based on new medical evidence (Cleveland Clinic, 2023).  The most recent update is the 2023 American Geriatrics Society Updated Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. This update involved an expert panel reviewing evidence published since the last update in 2019 and modifying the criteria to enhance usability and accuracy. By following these criteria, healthcare professionals can optimize medication regimens, make dose adjustments, or explore alternative treatments, especially for conditions like atrial fibrillation, heart failure, and Parkinson's disease.

## **How are the Beers Criteria used in clinical practice?** The Beers Criteria are used in clinical practice primarily as a guideline to help healthcare professionals, such as pharmacists, physicians, nurses, healthcare administrators, and researchers, make informed decisions regarding medication management for older adults. Here's how they are typically utilized: - **Screening for potentially inappropriate medications (PIMs)**: Healthcare providers use the Beers Criteria as a screening tool to identify medications that may pose higher risks or have limited effectiveness in older adults. They review a patient's medication list against the criteria to identify potentially inappropriate medications (PIMs). - **Guiding prescribing decisions**: Healthcare providers adjust medication regimens for older patients based on the Beers Criteria recommendations. They may discontinue or avoid certain medications known to be potentially inappropriate and explore alternative treatment options or adjust dosages to minimize risks. - **Educating healthcare professionals**: The Beers Criteria is an educational resource that helps them stay updated on the latest evidence-based recommendations for prescribing medications in older adults. This knowledge enables them to make more informed decisions that will improve health outcomes in their clinical practice. - **Facilitating interdisciplinary collaboration**: The Beers Criteria promotes multidisciplinary collaboration among healthcare professionals caring for older adults. Physicians, pharmacists, nurses, and other team members work together to review medication lists, identify potential issues, and develop appropriate management strategies. - **Supporting clinical decision-making**: Healthcare providers use the Beers Criteria to guide clinical decision-making regarding medication use in older adults with complex medical conditions. They consider factors such as renal function, cardiovascular status, cognitive function, and overall health when determining the appropriateness of specific medications. - **Promoting patient safety**: By adhering to the Beers Criteria recommendations, healthcare professionals help promote patient safety by minimizing the risk of adverse drug events, drug interactions, and other medication-related complications in older adults.

## **What are the specific criteria included in the Beers Criteria?** The Beers Criteria include specific criteria for potentially inappropriate medications (PIMs) and medication classes that may pose risks or have limited effectiveness in older adults. These criteria are regularly updated to reflect current evidence-based recommendations. Here are some of the critical criteria commonly included in the Beers Criteria, listed in the Journal of the American Geriatrics Society, published in 2023: ### **Medication classes to avoid in older adults** - **Benzodiazepines**: Due to increased risk of falls, confusion, and cognitive impairment. - **Anticholinergic medications**: May exacerbate cognitive decline and increase the risk of falls. - **Long-acting sulfonylureas**: Higher risk of hypoglycemia in older adults. - **Nonbenzodiazepine sedative-hypnotics**: Increased emergency room/visits and minimal improvement in sleep latency and duration. **Tricyclic antidepressants**: Higher risk of adverse effects, including orthostatic hypotension. ### **Individual medications to avoid in certain situations** - **Digoxin**: Avoid as first-line therapy for heart failure. - **Aspirin or NSAIDs**: Avoid primary prevention of cardiovascular disease. ### **Medications to use with caution** - **Antipsychotics**: Increased risk of stroke and greater rate of cognitive decline and mortality in persons with dementia. - **Antidepressants**: Highly anticholinergic, sedating, and cause orthostatic hypotension ### **Medication use in specific disease states** Avoiding certain medications in older adults with specific diseases such as Parkinson's disease, reduced ejection fraction, and heart failure.

## **How does our Beers Criteria Template work?** The Beers Criteria Template provides healthcare professionals with a comprehensive list of potentially harmful medications to elderly patients, the concerns associated with each medication, and suggested alternative treatments. Here's a breakdown of how it functions: ### **Step 1: Familiarize yourself with the medications included** After downloading a copy of the template, study the content of the Beers Criteria template. On it, you can find several medications that are categorized based on their therapeutic use, such as analgesics, antidepressants, antihypertensives, etc. This categorization helps you quickly find relevant information for the types of medication they're considering for their patients' treatment plans. ### **Step 2: Identify the risks** For each medication listed, the template outlines specific risks or concerns related to its use in the elderly. These concerns include an increased risk of gastrointestinal bleeding, confusion, dependency, renal failure, and more. Highlighting and knowing the risks helps assess the benefit-to-risk ratio of prescribing these medications to older adults. ### **Step 3: Read up on the alternative treatments** Perhaps the most actionable part of the template is its recommendations for alternative treatments. For each medication or medication class listed as potentially harmful, consider safer alternatives that can be used to achieve similar therapeutic outcomes with a lower risk of adverse effects in the elderly. ### **Step 4: Take note of the special considerations** The template also notes special considerations you need to remember, such as conditions where the risk of using a particular drug might be higher (e.g., using certain antidepressants in patients with a history of falls or seizures) or where a drug might still be used cautiously if necessary. ### **Step 5: Make use of the template** Beyond its immediate practical use in guiding prescription choices, the template is an educational tool for healthcare providers. It raises awareness about the pharmacological vulnerabilities of the elderly and emphasizes the importance of individualized, cautious prescribing. Keep in mind that the template aligns with efforts to improve the quality of care and safety for elderly patients. Informing providers about potentially inappropriate medications and suggesting alternatives contributes to reducing adverse drug events, hospitalizations, and other negative outcomes associated with improper medication use in older adults.

## **References** 2023 American Geriatrics Society Beers Criteria® Update Expert Panel (2023). American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 71(7), 2052–2081. https://doi.org/10.1111/jgs.18372 Cleveland Clinic (2023, May 4). Beers Criteria — Beers list of inappropriate medication used in older adults. https://my.clevelandclinic.org/health/articles/24946-beers-criteria