A comprehensive list of medications that older people should potentially avoid or consider using with caution

 Today, the American Geriatrics Society (AGS) released the 2023 update to the AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults (DOI: 10.1111/jgs.18372). The AGS Beers Criteria® serves as a comprehensive list of medications that older people should potentially avoid or consider using with caution because they often present unnecessary risks for this population. Given that, according to the National Center for Health Statistics, United States (NCHSUS), more than 88% of older people use at least one prescription and more than 66% use three or more in any given month, the AGS Beers Criteria® are  an important clinical, educational, c and quality assurance tool for clinicians across disciplines and the healthcare system as a whole.

“Medications have a vital role to play in helping us to remain healthy, active, and engaged in our communities,” said Donna M. Fick, PhD, GCNS-BC, FGSA, FAAN, AGSF, AGS President-elect and a member of the AGS Beers Criteria® Expert Panel. “The 2023 AGS Beers Criteria® is based on the best available evidence and supports person-centered decision-making that takes into account what matters to an older person, considers both drug and non-drug approaches to care, and is focused on maximizing health while minimizing unnecessary risk.”

Though not an exhaustive catalogue of inappropriate treatments, the five lists included in the AGS Beers Criteria® describe particular medications where the best available evidence suggests they should be:

1. Avoided by most older adults (outside of hospice and palliative care settings);
2. Avoided by older adults with specific health conditions;
3. Used with caution because of the potential for harmful side effects; or    
4. Avoided in combination with other treatments because of the risk for harmful “drug-drug” interactions; or
5. Dosed differently or avoided among older adults with reduced kidney function, which impacts how the body processes medicine.

First developed by the late Mark Beers, MD, and colleagues in 1991, the AGS took over maintenance and updating of the AGS Beers Criteria® in 2011. For the 2023 update, an expert panel reviewed more than 1,500 clinical trials and research studies published between 2017 and 2022. The resulting 2023 AGS Beers Criteria® include: 

• Over three dozen individual medications or medication classes to avoid for most older people. 
• 40+ medications or medication classes to use with caution or avoid when someone lives with certain diseases or conditions. 

The expert panel also moved several medications to different categories or revised guidance based on new evidence. To simplify and increase usability of the five lists comprising the criteria, the panel moved a number of medications to a separate list given that they have low usage or are no longer available in the United States. The panel still considers these medications as being potentially inappropriate for use in older adults in alignment with the 2019 criteria. 

“The AGS Beers Criteria® offers guidance about potentially harmful treatments for all of us as we age, supporting clinicians, patients, and caregivers to choose the safest, most effective treatment when making decisions that are individualized to what matters to the person. Our goal is to improve drug therapy and outcomes by identifying and reducing the prescribing of potentially inappropriate medications in older adults,” noted Todd Semla, MS, PharmD, BCGP, FCCP, AGSF, a co-chair of the 2023 AGS Beers Criteria® expert panel. “The AGS Beers Criteria® should never solely dictate how medications are prescribed or be used to justify restricting health coverage,” he added. “We encourage older adults who see one of their drugs listed on the AGS Beers Criteria to speak with their clinician about an alternative."

Published in its entirety in the Journal of the American Geriatrics Society (DOI: 10.1111/jgs.18372) the AGS Beers Criteria® is also available as a mobile app and as a pocket reference card. Both are designed to meet the needs of busy clinicians practicing in a variety of settings and are available from GeriatricsCareOnline.org. The AGS is committed to bringing the expertise of geriatrics health professionals to the public and lay versions of the Beers Criteria® as well as tools to aid older adults and caregivers in understanding what medications are potentially inappropriate are available for free from https://www.healthinaging.org/HealthinAging.org).

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