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The late Mark Beers (1954–2009) was an American geriatrician whose research on medications with potential harms to older adults that outweighed their potential benefits led to the establishment of the eponymous Beers Criteria for determining potentially inappropriate medication use in people age 65 and older.[1] Proposed in 1991 to identify medications to be avoided for nursing home residents[2] and expanded in 1997 to apply to all older adults,[3] the Beers criteria have been under the...
The late Mark Beers (1954–2009) was an American geriatrician whose research on medications with potential harms to older adults that outweighed their potential benefits led to the establishment of the eponymous Beers Criteria for determining potentially inappropriate medication use in people age 65 and older.[1] Proposed in 1991 to identify medications to be avoided for nursing home residents[2] and expanded in 1997 to apply to all older adults,[3] the Beers criteria have been under the stewardship of the American Geriatrics Society since 2010. One of the advisors to Dr. Beers in developing the initial criteria was Dr. Sidney M. Wolfe, the Health Research Group Founder and Senior Adviser.
In 2023, the American Geriatrics Society updated the Beers Criteria, as it has done three times before.[4] The criteria are specifically designed for use in the United States and “are intended to be applied to adults 65 years old and older in all ambulatory, acute and institutionalized settings of care, except hospice and end-of-life care settings.” Although the greatest use of the Beers Criteria is by practicing clinicians followed by educators, researchers, health care administrators and regulators, the criteria are worth knowing about because of their important effects on improving medication selection, reducing the exposure of older adults to potentially inappropriate medications and supporting shared clinical decision-making with patients. The five general categories are medications considered as: 1) potentially inappropriate, 2) potentially inappropriate in patients with certain diseases or syndromes, 3) to be used with caution, 4) potentially inappropriate drug-drug interactions and 5) whose dosages should be adjustedbased on renal function.
The 12 members of the expert panel for the 2023 update were drawn from medicine, nursing and pharmacy, and recused from discussion on topics where they had disclosed a conflict of interest. Additional “ex-officio” members came from the Center for Medicare & Medicaid Services, the National Committee for Quality Assurance and the Pharmacy Quality Alliance.
The new report is 30 pages long with detailed, tabulated and nuanced recommendations. Among the many noteworthy revisions is a change to the criteria involving anticoagulation. The recommendation for rivaroxaban (XARELTO) was changed from “use with caution” to “avoid” for long-term treatment of non-valvular atrial fibrillation and venous thromboembolism, because of its increased risk of major and gastrointestinal bleeding as compared to other direct-acting oral anticoagulants, such as apixaban (ELIQUIS) and dabigatran (PRADAXA). Dabigatran, however, remained as a “use with caution” medication for the long-term treatment of these conditions, because of its increased risk of gastrointestinal and major bleeding compared with safer alternatives such as apixaban. Previously, Public Citizen’s Health Research Group has classified rivaroxaban,[5] dabigatran[6] and apixaban[7] as Do Not Use drugs. In a future issue, we will report on updated evidence about direct-acting oral anticoagulants.
References
[1] Pearce J. Mark H. Beers, 54, expert on drugs given to elderly, dies. New York Times, March 9, 2009. https://www.nytimes.com/2009/03/10/health/10beers.html. Accessed September 7, 2023.
[2] Beers MH, Ouslander JG, Rollingher I, et al. Explicit criteria for determining inappropriate medication use in nursing home residents. Arch Intern Med. 1991;151:1825-1832. doi:10.1001/archinte. 1991.00400090107019
[3] Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly: an update. Arch Intern Med. 1997;157:1531-1536. doi:10.1001/archinte. 1997.00440350031003.
[4] American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriarte medication use in older adults. J Am Geriatr Soc. 2023;71:2052-2081. doi: 10.111/jgs.18372
[5] Overview of the blood thinner rivaroxaban (XARELTO): an update. Worst Pills, Best Pills News, May 2021. https://www.worstpills.org/newsletters/view/1397. Accessed September 7, 2023.
[6] Do not ‘go with the flow’ for dabigatran (PRADAXA)! Worst Pills, Best Pills News, September 2016. https://www.worstpills.org/newsletters/view/1057. Accessed September 7, 2023.
[7] Do not use the new oral blood thinner apixaban (ELIQUIS), Worst Pills Best Pills News, June 2018. https://www.worstpills.org/newsletters/view/1202. Accessed September 7, 2023.
