All rights Reserved. This grading system rates the quality of evidence regarding health outcomes in an appropriate population as high (i.e., consistent results from at least two randomized controlled trials or multiple, consistent observational trials), moderate (i.e., sufficient evidence from at least one high quality trial with more than 100 participants, at least two high quality trials with some inconsistency, at least two lower quality trials with consistent results, or multiple consistent observational trials with flawed methodology), or low (i.e., insufficient evidence based on small or inadequately powered studies, inconsistent results from large trials, or trials with significant methodological flaws).In addition, the grading system rates the strength of recommendations as strong (i.e., risks plainly outweighs benefits or vice versa), moderate (i.e., risks and benefits are balanced), or weak (i.e., lack of sufficient evidence to establish benefits or risks).
Potentially Harmful Drugs in the Elderly: Beers List and More (B=Beers list drug; C=Canadian list drug) Drug Concern Alternative Treatment Analgesics Ketorolac (Toradol) (B); long-term use (C) GI bleeding.5 Meperidinea (Demerol) (B); long-term use (C) Not effective at commonly used oral doses; confusion, falls, factures, dependency, withdrawal5,15
In this update, some medications were removed from the list of potentially inappropriate medications for most older patients and for those with certain conditions, as well as the list of those that should be used cautiously. 2015 American Geriatrics Society (AGS) Beers Criteria for Potentially Inappropriate Medication Use in Older Adults For patients with dementia, histamine H2 receptor antagonists were removed because the evide… Notable new additions include thiazolidinediones for patients with heart failure, acetylcholinesterase inhibitors in patients with a history of syncope, and selective serotonin reuptake inhibitors in those with a history of falls or fractures. • Avoid most antipsychotics in patients with Parkinson disease complicated by psychosis, although quetiapine, clozapine, and pimavanserin may be used with caution.• Avoid using rivaroxaban and dabigatran in older adults because of a higher bleeding risk than warfarin and other direct oral anticoagulants.• Avoid tramadol use because of the risk of hyponatremia from syndrome of inappropriate antidiuretic hormone secretion.• Avoid prescribing opioids with benzodiazepines or gabapentinoids because the combinations increase the risk of severe respiratory depression.The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults (i.e., at least 65 years of age), originally developed by Mark H. Beers in 1991, continue to be used by the American Geriatrics Society (AGS) to provide guidance regarding medications that should be avoided in most older patients or in certain situations.
The information presented in the criteria should serve only as a guide, with care tailored to each patient’s needs.See how you can participate in the APhA2021 program.© Copyright 2020, American Pharmacists Association All Rights Reserved. In all, 2,169 references were reviewed by a panel of experts in the field of geriatric care. The new criteria list both the quality of evidence and strength of the recommendations next to each medication or drug class.The update includes three groups of medications: medications to avoid in older adults regardless of diseases or conditions; medications considered potentially inappropriate when used in older adults with certain diseases or syndromes; and a new, third group of medications that should be used with caution in older adults.
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