Potentially Inappropriate Medications for Older Adults: 65 and Older Based on Updated Beers Criteria
Potentially inappropriate medication use in adults 65 years and older in the United States based on revised and updated 2000 Beers criteria.
The Beers criteria are based on expert consensus developed through an extensive literature review with a bibliography and questionnaire evaluated by nationally recognized experts in geriatric care, clinical pharmacology, and psychopharmacology using a modified Delphi technique to reach consensus. The Beers criteria have been used to survey clinical medication use, analyze computerized administrative data sets, and evaluate intervention studies to decrease medication problems in older adults.
With the continuous arrival of new drugs on the market, increased knowledge about older drugs, and removal of older drugs from the market, these criteria go through updates on a regular basis to remain useful. Since the criteria were published in 1997, there has been an increase in the number of scientific studies addressing drug use and appropriateness in older adults, but there is still a lack of controlled studies in the older population and particularly in patients older than 75 years and patients with multiple comorbidities. An initiative by Donna M. Fick, PhD, RN, et al.to revise and update the Beers criteria for ambulatory and nursing facility populations older than 65 years in the United States aimed to:
(1) To reevaluate the 1997 criteria to include new products and incorporate new information available from the scientific literature.
(2) To assign or reevaluate a relative rating of severity for each of the medications.
(3) To identify any new conditions or considerations not addressed in the 1997 criteria.
The list below contains medications or medication classes that should generally be avoided in persons 65 years or older because they are either ineffective or they pose unnecessarily high risk for older persons and a safer alternative is available. They are concluded to be inappropriate to use independent of diagnoses or conditions and marked with HIGH or LOW Severity Rating of Adverse drug events (ADEs).
Example of Drugs with HIGH Severity Rating
Independent of patient conditions and diagnosis Drug Generic Name:Brand Name Nifedipine:Adalat Methyldopa:Aldomet Methyldopa-hydrochlorothiazide:Aldoril Naproxen:Aleve Methyltestosterone:Android Hydroxyzine:Atarax Naproxen:Avaprox
With specific conditions Drug Generic Name:Brand Name : Disease or Condition Disopyramide:Norpace : Heart failure Methylphenidate:Ritalin : Cognitive impairment
Example of Drugs with LOW Severity Rating
Independent of patient conditions and diagnosis Drug Generic Name:Brand Name Cyclandelate:Cyclospasmol Isoxsurpine:Vasodilan
With specific conditions Drug Generic Name:Brand Name : Disease or Condition Olanzapine:Zyprexa : Obesity Fluoxetine:Prozac : SIADH/hyponatremia
Aiman Alrawabdeh 5/28/2006
Donna M. Fick, PhD, RN, et al. Updating the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults:Results of a US Consensus Panel of Experts. Archives of Internal Medicine. 2003;163:2716-2724