Encyclopedia2015

Beers Criteria

The Beer’s criteria provide guidance for physicians and pharmacists to prevent the use of potentially inappropriate medications in older adults over 65 years of age. The pharmacokinetics of drug absorption, distribution, metabolism and excretion are altered in the older adult. As a result, “medication’s toxic effects and drug related problems can have profound medical and safety consequences for older adults” (Fick, et al., 2003).

The Beer’s criteria, developed by an expert consensus panel headed by Mark H. Beers in 1991, identifies medications whose risks may outweigh the therapeutic benefits in older adults. Beer’s criteria are widely used, and have been adopted by the Centers for Medicare & Medicaid (CMS) for nursing home regulation (Fick, et al., 2003). The development of new drugs, increased knowledge of existing drugs, and the removal of medications on the market led to the Beer’s criteria being updating in 1997 and most recently in 2003.

The updated criteria lists 48 medications or medication classes to be avoided in the older adult, the concern for its use, and a severity rating. The second part of the updated Beers criteria lists 20 diagnoses and conditions with medications to be avoided in the older adult. Included are 66 potentially inappropriate drugs that have high severity ratings to cause adverse drug events (Moloney, 2008).

Despite its extensive use, many healthcare providers continue to prescribe medications with high severity ratings. 23% of older adults have been prescribed at least one medication on the Beer’s list (Zwicker & Fulmer, 2008). Nursing knowledge of the Beer’s criteria facilitates monitoring for adverse effects and prevention of adverse drug events (Moloney, 2008).

Links

Note: NICHE Encyclopedia provides links to third-party web sites, however, NICHE & the Hartford Institute for Geriatric Nursing does not recommend and does not endorse any products or any of the content on any third-party websites.

References

  • Aparasu, R. R., & Mort, J. R. (2000). Inappropriate prescribing for the elderly: Beers criteria-based review. Annals of Pharmacotherapy, 34, 338-46.
  • Beers, M. H. (1997). Explicit criteria for determining potentially inappropriate medication use by the elderly: An update. Archives of Internal Medicine, 157(14), 1531-1536.
  • Bergmann-Evans, B. (2004). Improving medication management for older adult clients. Retrieved on March 30, 2009 from: http://www.guideline.gov/summary/summary.aspx?doc_id=6222&nbr=003993&string=beer's+AND+criteria.
  • Bonk, M. E., Krown, H., Matuszewski, K., & Oinonen, M. (2006). Potentially inappropriate medications in hospitalized senior patients. American Journal of Health-System Pharmacy, 63(12), 1161-1165.
  • Fick, D. M., Cooper, F. W., Wade, W. E., Waller, J. L., Maclean, J. R., & Beers, M. H. (2003). Updating the Beers criteria for potentially inappropriate medication use in older adults. Archives of Internal Medicine, 163(22), pgs. 2716-2724.
  • Fu, A. Z., Liu, G. G., & Christensen, D. B. (2004). Inappropriate medication use and health outcomes in the elderly. Journal of the American Geriatrics Society, 52(11), 1934-1939.
  • Hanlon, J. T., Schmader, K. E., Boult, C, Artz, M., Fillenbaum, G., Ruby, C. M., & Garrad, J. (2002). Use of inappropriate prescription drugs by older people. Journal of the American Geriatrics Society, 50, 26-34.
  • Hanlon, J., Fillenbaum, G., Kuchibhatla, M., Artz, M., Boult, C., Gross, C., Garrard, J., & Schmader, K. (2002). Impact of inappropriate drug use on mortality and functional status in representative community dwelling elders. Medical Care, 40(2), 166-176.
  • Health Benchmarks. (2006). Appropriate medication use in the elderly. Retrieved March 30, 2009 from: http://bcbstx.com/provider/pdf/v58_elderly2.pdf.
  • Lau, D. T., Kasper, J. D., Potter, D. E., Lyles, A., & Bennett, R. G. (2005). Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents. Archives of Internal Medicine, 165(1), 68-74.
  • Liu, G. G., & Christensen, D. B. (2002). The continuing challenge of inappropriate prescribing in the elderly: An update of the evidence. Journal of the American Pharmaceutical Association, 42(6), 847-857.
  • Moloney, S. (2008). Beers criteria for potentially inappropriate medication use in older adults art II: 2002 criteria considering diagnoses or conditions. Retrieved on March 31, 2009 from: http://www.consultgerirn.org/uploads/File/trythis/issue16_2.pdf.
  • Mort, J. R., Aparasu, R. (2000). Prescribing potentially inappropriate psychotropic medications to the ambulatory elderly. Archives of Internal Medicine,160(18), 2825-2831.
  • Sloane, P., Zimmerman, S., Brown, L., Ives, T., & Walsh, J.(2002). Inappropriate medication prescribing in residential care/assisted living facilities. Journal of the American Geriatrics Society, 50(6), 1001-1011.
  • Spina, E., & Scordo, M. G. (2002). Clinically significant drug interactions with antidepressants in the elderly. Drugs & Aging, 19(4), 299-320.
  • Tune, L. E. (2001). Anticholinergic effects of medication in elderly patients. Journal of Clinical Psychiatry, 62 Suppl (21), 11-4.
  • Ruscin, J. M., & Page, R. L. (2002). Inappropriate prescribing for elderly patients. The Journal of the American Medical Association, 287, 1264-1265.
  • Zhan, C., Correa-de-Araujo, R., Bierman, A. S., Sangl, J., Miller, M. R., Wickizer, S., et al. (2005). Suboptimal prescribing in elderly outpatients: Potentially harmful drug-drug interactions and drug-disease interactions. Journal of the American Geriatrics Society, 53, 262-267.
  • Zhan, C., Sangl, J., Bierman, A. S., Miller, M. R., Friedman, B., & Wickizer, S. W., et al. (2001). Potentially inappropriate medication use in the community-dwelling elderly: Findings from the 1996 expenditure panel survey. Journal of the American Medical Association, 286(22), 2823-2829.
  • Zwicker, D., Fulmer, T. (2008). Reducing adverse drug events. In E. Capezuti, D. Zwicker, M. Mezey, T. Fulmer, D. Gray-Miceli, & M. Kluger, (Eds.). Evidence-based geriatric nursing protocols for best practice: Third Edition. New York: Springer Publishing Company.