Beers Criteria
The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults is the most frequently consulted reference for healthcare professionals about the safety of prescribing medications for older adults. The criteria are used widely in geriatrics clinical care, training, and research, as well as in healthcare policy and the development of quality measures. The Beers Criteria, as it is commonly called, identify medications that pose risks outweighing their potential benefits for people 65 and older. This information can help prevent harmful and life-threatening medication side effects and other “adverse drug events” (ADEs) among older people. Each year, more than a third of older adults experience at least on ADE. With the eldest of the nation’s 77 million Baby Boomers now turning 65, safe prescribing for older adults is becoming an increasingly important aspect of healthcare safety and quality.
The Beers Criteria is meant to serve as a guide for clinicians and should not substitute for professional judgment, dictate prescribing decisions for an individual patient, or be used in any way in a punitive manner. Evidence from both the recent Budnitz study [1], which addresses emergency hospitalizations for ADEs in older Americans, and the STOPP/START criteria (Screening Tool of Older Persons Potentially Inappropriate Prescriptions and Screening Tool to Alert Doctors to the Right Treatment) [2] should be used in a complementary manner with the Beers Criteria to guide clinicians about safe prescribing in older adults.
The late Mark H. Beers, MD, a geriatrician, first created the Beers Criteria in 1991, through consensus of a panel of experts by using the Delphi method. The criteria were originally published in the Archives of Internal Medicine in 1991 [3] and were updated in 1997 and again in 2003.
In 2011, the American Geriatrics Society (AGS) convened an 11-member multidisciplinary panel of experts in geriatric medicine, nursing, and pharmacotherapy to develop the 2012 American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.
The 2012 AGS Beers Criteria differ from previous editions in several ways. In addition to using a modified Delphi process for building consensus, the expert panel followed the evidence-based approach that AGS has used since it developed its first practice guideline on persistent pain in 1998. The Institute of Medicine (IOM) in its 2011 report, Clinical Practice Guidelines We Can Trust, [4] recommended that all guideline developers complete a systematic review of the evidence. Following the recommendation of the IOM, AGS added a public comment period that occurred in parallel to its standard invited external peer review process. In a significant departure from previous versions of the criteria, each recommendation is rated for quality of both the evidence supporting the panel’s recommendations and the strength of their recommendations. It is important to note that because medically complex older adults are often excluded from clinical trials, there is a shortage of evidence focused on this specific population.
In another departure from the 2003 criteria, the 2012 AGS Beers Criteria identify and group medications that may be inappropriate for older adults into three different categories instead of just two, as previously. The first category includes medications that are potentially inappropriate for older people because they either pose high risks of adverse effects or appear to have limited effectiveness in older patients, and because there are alternatives to these medications. The second category includes medications that are potentially inappropriate for older people who have certain diseases or disorders because these drugs may exacerbate the specified health problems. The newly added third category includes medications to be used with caution in older adults. These medications, while associated with more risks than benefits in older people in general, nonetheless may be the best choice for a particular individual if administered with particular caution. The addition of this third category is important, emphasizing as it does the necessity of tailoring prescribing to the unique needs of each patient.
The 2012 AGS Beers Criteria will be officially released the week of February 27th via publication in the early online edition of the Journal of the American Geriatrics Society (JAGS) and will available at www.americangeriatrics.org. The AGS is developing a process for periodic updates to the criteria.
[edit] References
- ^ Emergency Hospitalizations for Adverse Drug Events in Older Americans” Daniel S. Budnitz, M.D., M.P.H., Maribeth C. Lovegrove, M.P.H., Nadine Shehab, Pharm.D., M.P.H., and Chesley L. Richards, M.D., M.P.H. N Engl J Med 2011;365:2002-12. Copyright © 2011 Massachusetts Medical Society.
- ^ Hilary Hamilton, MB, MRCPI; Paul Gallagher, PhD, MRCPI; Cristin Ryan, PhD, MPSI; Stephen Byrne, PhD, MPSI; Denis O’Mahony, MD, FRCPI. Potentially Inappropriate Medications Defined by STOPP Criteria and the Risk of Adverse Drug Events in Older Hospitalized Patients. Arch Intern Med. 2011;171(11):1013-1019. doi:10.1001/archinternmed.2011.215
- ^ Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH (December 8, 2003). "Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts". Archives of Internal Medicine 163 (22): 2716–2724. doi:10.1001/archinte.163.22.2716. PMID 14662625.
- ^ http://www.iom.edu/Reports/2011/Clinical-Practice-Guidelines-We-Can-Trust.aspx
