Medications that Older Adults Should Avoid or use with Caution

The 2019 American Geriatrics Society Updated Beers Criteria®

For more than 20 years, the AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults have been a leading source of information about safely prescribing medications for older people. The AGS Beers Criteria® identify medications with risks that may be greater than their benefits for people age 65 and older. 

The AGS reviews and updates the AGS Beers Criteria® on a regular basis because new medications are created and new research is published that provides information on the safety of existing treatments. In 2019, the AGS Beers Criteria® were again updated by an expert panel of healthcare and pharmacy experts to help prevent potential medication side effects and other medication-related problems in older adults.

Why Experts Developed the AGS Beers Criteria®

As you get older, your body changes. These changes can increase the chances that you’ll have side effects when you take medications. Older people often have more health problems and take more medications than younger people. Because of this, older adults are more likely to experience harmful interactions between different medications. In fact, one in six adults age 65 or older will likely have one or more harmful reactions to a medication or medications. This is why it’s important to identify and help reduce the use of medications that are associated with more risks than benefits in older people.

What the 2019 AGS Beers® Criteria Include

Using a time-tested method for developing treatment guidelines, and following the recommendations of the Institute of Medicine, members of the AGS Beers Criteria® expert panel reviewed 6,700 high-quality research studies about certain potentially inappropriate medications prescribed for older adults.

Based on the review of this research, the experts updated lists of:

  • Medications and types of medications that are “potentially inappropriate” for older people. Healthcare providers should consider avoiding medications on this list when prescribing for adults age 65 and older. These medications generally pose a higher risk of side effects, may not work as well in an older person, and can sometimes be replaced with safer or more effective medications or non-medication remedies. 
  • Medications that are potentially inappropriate for older adults with certain common health problems. Older adults often have other specific diseases or disorders that some medications may make worse.
  • Types of medications that should be used with caution in older adults. Medicines on this list can cause medication-related problems.  There is less agreement by the experts about the balance of benefits and harms of these drugs in older adults, and they may be the best choice available for certain older adults. However, healthcare providers and patients need to carefully monitor how these medications are working and keep an eye out for side effects.
  • A list of medication combinations that may result in harmful ”drug-drug” interactions.  Medications for several conditions common in older adults may be inappropriate when prescribed at the same time.  In each of the combinations of medication or medication classes listed, the medications interact with each other to put older adults at higher risk of serious side effects.
  • Medications that should be avoided or have their dose changed in people with poor kidney function.  Because the kidneys help to filter many medications from the body, people with reduced kidney function may react poorly to certain medications.

Related Resource:  Alternatives to Potentially Inappropriate Medications on the Beers® Criteria

The AGS understands that older adults, healthcare providers, and other people and organizations involved in health care might benefit from suggestions for alternatives to potentially inappropriate medications.  In response, AGS created a list of certain suggested alternative medications and treatment options that are not prescribed medications. This list of alternatives is meant to be used alongside the AGS Beers Criteria® for additional guidance.

To access the complete AGS Beers Criteria® and its related resources, please visit GeriatricsCareOnline.org.

How Health Professionals Are to Use this List

Healthcare providers refer to the AGS Beers Criteria® when deciding whether and what to prescribe for older adults, but they should not make these decisions based only on the AGS Beers Criteria®. Among other reasons, they shouldn’t do this because the AGS Beers Criteria® don’t apply to all situations that older patients face. The AGS Beers Criteria®, for example, don’t take into account all of the unique circumstances for older people receiving palliative or hospice care.

Because the AGS Beers Criteria® shouldn’t dictate what healthcare providers prescribe, healthcare providers should not be penalized for prescribing a medication for an older person simply because it is on one of the AGS Beers Criteria® lists. Different older adults respond differently to the same medication, and for some people, the medications listed in the AGS Beers Criteria® will be the best choices. 

The AGS Beers Criteria® are meant to be used as a resource for healthcare providers, not a replacement for their experience and knowledge. 

It’s also important to remember that “potentially inappropriate” medications are just that—potentially inappropriate.  They should be considered carefully before use, but that doesn’t mean that they should never be used in all cases or for any older people.

What Older Adults Can Do

To lower the chance of medication-related problems:

  • Keep a list of all of the medications you take—both non-prescription and prescription. This includes any supplements that you take, such as vitamins. You should also write down the doses, and remember to bring the list with you whenever you see a healthcare professional. This way, he or she will know what medications and supplements you are taking and can check whether these might be causing side effects, or could cause side effects, if taken along with a new medication.
  • Ask what side effects your medications can cause, and watch for them. If you think you may be having a bad reaction to a medication, or if you think a medication is not working, tell your healthcare provider as soon as possible. However, don’t stop taking a medication without first checking with a healthcare professional.
  • Talk with your healthcare provider if a medication you are taking is in the AGS Beers Criteria®.  Ask if there might be a safer or more effective alternative. Keep in mind that if a medication you take is on the AGS Beers Criteria®, it still may be a reasonable choice for you. The way you respond to a medication or medications can differ from the way other people respond to it. Medications included in the AGS Beers Criteria® are “potentially inappropriate,” but can be reasonable choices for some older adults.

This summary is from the full report titled American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults

 

Last Updated January 2019