The 2015 Updated AGS Beers Criteria: What’s New

Donna-Fick headshotTodd-Semla headshot

Donna M. Fick, PhD, RN, GCNS-BC, FGSA, FAAN

Todd P. Semla, PharmD, MS, AGSF

Co-Chairs of the 2015 Updated AGS Beers Criteria Expert Panel

 

 

 

Today, the American Geriatrics Society (AGS) released its 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. For more than 20 years, the Beers Criteria have served as a valued resource for healthcare professionals about the safety of prescribing medications to older adults. In fact, the AGS Beers Criteria have become one of the most frequently used reference tools in the field of geriatrics. The AGS Beers Criteria were previously updated in 2012.

How We Updated the Beers Criteria
The 2015 Updated AGS Beers Criteria reflect work done by a panel of 13 geriatrics experts convened by the AGS. The panel searched for clinical trials and research studies since the 2012 AGS Beers Criteria were issued, and found more than 20,000 results! From this pool, our team reviewed more than 6,700 studies. From there, we were able to identify more than 40 potentially problematic medications or classes of medications, which we organized into five lists. While these lists aren’t exhaustive, they can be very helpful as conversation-starters between older adults and their healthcare providers about what treatment options work best from one individual to the next.

What’s New?
In addition to updating two lists of medications that may be potentially harmful for people aged 65 and older who are not receiving palliative or hospice care, the 2015 Updated AGS Beers Criteria now contain:

  • Separate guidance on avoiding 13 combinations of medications known to cause harmful “drug-drug interactions.” Some medications may be inappropriate when prescribed together because they can increase an older adult’s risk for falls, fractures, or urinary incontinence, for example.
  • A list of 20 potentially problematic medications to avoid or for which doses should be adjusted depending on an older person’s kidney function. These medications could raise risks for problems such as nausea, diarrhea, bleeding, problems affecting the brain and nervous system, and changes in mental well-being and bone marrow toxicity (a condition in which bone marrow makes fewer blood cells).
  • Three new medications and two new “classes” of medications added to the Criteria. An example of a new class of medication includes the proton-pump inhibitors that some people take for acid reflux or stomach ulcers. Recent studies have linked these medications to an increased risk for bone loss, fractures, and serious bacterial infections, which is why they were added to the 2015 AGS Beers Criteria.

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It’s Baaack! The Flu Season, That Is…

Shah headshot

Krupa Shah, MD, MPH
Assistant Professor
University of Rochester School of Medicine & Dentistry

Like it or not, the flu season is back. Everybody should take notice, especially older adults. This blog post will give you some tips on how to prevent getting the flu.

 

 

Why is it especially important for older adults to be extra careful about the flu?

  • In general, older adults have weaker immune systems compared to younger adults. This is a result of the aging process. In fact, people 65 years or older are at the greatest risk of complications from the flu.
  • Older adults become sick more frequently, which often results in hospitalization.

What are some of the more common flu symptoms?

  • Fever
  • Cough
  • Runny nose
  • Sore throat
  • Body aches
  • Headaches
  • Chills
  • Fatigue

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Walking is the Best Medicine!

Lacing up your shoes and getting out the door is one of the best things older adults can do for their health and mood.

Barb Resnick HeadshotBarbara Resnick, PhD, CRNP
Professor
Sonya Ziporkin Gershowitz Chair in Gerontology
University of Maryland School of Nursing

The Surgeon General’s new “Call to Action on Walking” is a perfect opportunity to celebrate the many physical and mental health benefits of walking. In fact, if the benefits of walking came in pill form, I’m convinced it would be the best-selling pill on the planet! Walking is a scientifically proven, simple way to dramatically improve your well-being. No matter how old you are, when you walk regularly, you can enjoy benefits like these:

  • You can lower your blood pressure and cholesterol
  • You will start feeling happier, less anxious, and less stressed
  • Your sleep can become sounder and more restful
  • You may be able to lessen your risk of falling and reduce your fear of falling
  • You can prevent gaining weight
  • Your mental sharpness can improve

Recently, researchers from Johns Hopkins University discovered that for older women (but not older men), a low-intensity daily walk might enlarge the part of the brain responsible for memory. Known as the hippocampus, this section of the brain is linked to memory loss when it shrinks due to aging. [Varma et al. Low-Intensity daily walking associated with hippocampal volume in older adults. Hippocampus. 2015 May;25(5):605-15] 

Although we know that there is little risk associated with walking, many older adults are afraid that walking might worsen conditions such as arthritis. But the good news is that the opposite is true. In fact, when you walk just 3,000 steps a day, you can prevent the pain of knee arthritis from getting worse. And people who walk 6,000 steps a day (about 3 miles) can reduce their chances of becoming disabled by arthritis.

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“The Four M’s” of Caring for an Older Adult with Dementia

Cleveland, MaryJo 4x6Maryjo L. Cleveland, MD
Medical Director, Post Acute & Senior Services
Chief, Division of Geriatric Medicine
Summa Health System
Akron, Ohio

Your older relative has just been diagnosed with dementia. Your head is spinning with questions, concerns, fears, and yes, disbelief.  Still, you want to know all you can. If you are going to be a caregiver, you want to be a good one. So, where to start?

Start with the things that, if not managed well, have the greatest chance of getting your relative into trouble! Start with “The Four M’s.”

 

Meals
From planning to shopping to preparing, meal preparation is a very complicated task—for someone with a memory problem. You may notice that the older person is losing weight, that they eat little at home but eat well when they go out to eat, or that there is spoiled food in the refrigerator.

Try: Have simple foods – especially your relative’s favorite ones – around the house, such as sandwiches, soup, and cereal. Bring in ready meals that just need to be microwaved. Consider arranging for home delivered meals. Try to make meal time a social time when possible. Ask friends, church and family members to stop in and stay during meals.

Medicine
Medication management can also be overwhelming and older adults are often taking 10 or more medications, including over-the-counter ones.

Try: Discuss simplifying the regimen with the primary healthcare provider. Are all medications still necessary, and how many can be given just daily? Set up the medicine in a “days of the week” pill box and monitor if they are being taken. Call daily to remind. Consider hiring help for in-person reminders. Take over the refill tasks. Continue reading

Finally summer! Time to get some sunshine!

Syed picQuratulain Syed, MD
Assistant Professor of Medicine,
Division of General Medicine and Geriatrics,
Emory University School of Medicine

Now that the long, harsh winter is over and the Sun has finally decided to shine on people living beyond Florida, it’s time to take advantage of the warm weather while it lasts. So ladies and gentlemen, let’s head out to lose the pounds you put on eating your favorite pies the last holiday season.

Outdoor activities have many health benefits, including helping your body make vitamin D, losing unwanted pounds, helping lower your blood pressure, and keeping your heart healthy. While outside, it’s important to take some precautions to avoid getting sick from excessive heat exposure. Here are some tips to help you enjoy the sun:

  • Walk in the early morning (before 10am) or late evening hours (2-3 hours prior to sunset) to avoid excessive heat exposure.
  • Keep a bottle of water with you and sip from it while you are out to avoid getting dehydrated.
  • Wear light colored, loose fitting, and lightweight clothing (such as cotton).
  • Get your hats out and wear them. You get to show them off and avoid the direct heat of the sun.
  • To prevent sunburns and skin cancer, buy sunblock lotion or spray from your local pharmacy and apply it liberally on all exposed parts of your body.
  • Choose pavement or a shaded trail in a park to walk on. Make sure to select a trail which is clean and even, to avoid stumbling on slippery stones and rocks. If you have been under trees and walked through grass, check for ticks on your skin and in skinfolds. Ticks prefer to be in hot moist areas. Also check your scalp after you get home. Have a healthcare provider remove the tick if you find one attached to your skin.
  • Try going to an indoor shopping mall to walk. However, if you love to shop, you might want to leave your credit card at home!
  • Be mindful of your surroundings and be sure to walk in well-lit, clean, and safe walking spaces. Let someone know where you are going and when you expect to return. Take your cell phone with you!
  • Water exercises are a great way to stay in shape for everyone, including people with joint aches and arthritis who can’t walk or run long distances. If there is a swimming pool available at the community center near you, ask about their water exercise schedule. If there are no water exercise classes, put your swimsuit on and walk from one shallow end to the other.
  • Pack some light snacks as low-salt crackers, vegetables (e.g., carrots, cucumbers etc.), and peanut butter to enjoy while you sit on a bench to rest during and after a long walk.
  • Make sure to wear comfortable walking shoes with good support and cushioning. No high heels!
  • If you have one, remember to bring your cane or walker with you. You might need it if you get exhausted from the exercise.
  • Keep your medicine list and emergency contact information in your wallet or handbag at all times.
  • If you experience a severe headache, nausea, spinning of your head, too much sweating, or your heart racing very fast, it may be signs of a condition called heat exhaustion. If this happens, do not wait. Alert your companion or asking people passing by to help you to a shaded place and call for help.

Enjoy the summer and stay safe!

About the Author
Dr. Syed is a member of the American Geriatrics Society’s Public Education Committee.