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Updated Beers Criteria intended to reduce inappropriate medication use
The latest version of the American Geriatrics Society’s Beers Criteria provides guidance for clinicians on which medications most of their patients aged 65 years and older should avoid, which medications these patients should use with caution and which medications are now deemed appropriate for this age group, according to a press release.
“The goal of the 2019 update continues to be improving the care of older adults by reducing their exposure to [potential inappropriate medication] that have an unfavorable balance of benefits and harms compared with alternative treatment options,” the 2019 American Geriatrics Society Beers Criteria Update Expert Panel wrote.
“The intention ... is to improve medication selection; educate clinicians and patients; reduce adverse drug events; and serve as a tool for evaluating quality of care, cost, and patterns of drug use of older adults,” it added.
Several studies have suggested a significant amount of inappropriate medication use among the elderly. One study concluded that approximately one in three fee-for-service beneficiaries with Medicare A, B or D who were aged 65 years and older received an inappropriate medication.
Some of the “noteworthy changes” made to the Beers Criteria include:
- ciprofloxacin in combination with theophylline increases risk for theophylline toxicity;
- cyclooxygenase-2 inhibitors, dronedarone, NSAIDs and thiazolidinediones (“glitazones”) should now be avoided in older adults with heart failure who are symptomatic and used with caution in such adults who are asymptomatic;
- macrolides (not including azithromycin or ciprofloxacin) used in combination with warfarin increases risk for bleeding;
- nondihydropyridine calcium channel blockers should now be avoided in older patients with heart failure and reduced ejection fraction;
- concurrent use of opioids and benzodiazepines or gabapentinoids should be avoided in most cases; and
- trimethoprim-sulfamethoxazolen use in combination with warfarin or phenytoin increases risk for bleeding and phenytoin toxicity, respectfully.
- The panel also advised their guidelines should not be seen as the final word on a drug or drug class.
“Prescribing decisions are not always clear-cut, and clinicians must consider multiple factors, including discontinuation of medications no longer indicated. Quality measures must be clearly defined, easily applied, and measured with limited information and, thus, although useful, cannot perfectly distinguish appropriate from inappropriate care,” the panel wrote. – by Janel Miller
References:
2019 American Geriatrics Society Beers Criteria Update Expert Panel. J Am Geriatr Soc. 2019;doi:10.1111/jgs.15767.
Jiron M, et al. J Am Geriatr Soc. 2016;doi:10.1111/jgs.14077.
Disclosures: Healio Primary Care Today was unable to determine authors’ relevant financial disclosures prior to publication.