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).


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