American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older AdultsMeredith CookMercer COPHSAugust, 2012

Beers CriteriaAGS and interdisciplinary panel of 11 experts in geriatrics and pharmacotherapy53 medications or medication classesThree categories:Potentially inappropriate medications and classes to AVOID in older adultsPotentially inappropriate medications and classes to AVOID in older adults with certain diseases and syndromesMedications to be used in CAUTION in older adultsExpert Panel expertise in geriatric medicine, nursing, pharmacy practice, research, and quality measuresAlso members from CMS, NCQA, and PQA were invited to serve as members of the panel2Beers CriteriaThis update will allow for:Closer monitoring of medication useReal-time e-prescribing and interventions to decrease adverse drug events in older adultsBetter patient outcomesMedication Related ProblemsCommon, costly, and often preventable27% of ADEs in primary care and 42% of ADEs in LTC were PREVENTABLE Most problems occurred at ordering and monitoring stages of therapyTotal healthcare expenditures related to use of PIMs was $7.2 billion in 2000/2001 Medical Expenditure Panel SurveyMedication Related ProblemsExplicit Criteria unfavorable balance of risk vs. benefit consider alternate therapyImplicit Criteria therapeutic duplication and drug-drug interactions

Both of these have been taken into consideration when compiling the Beers ListPIMsLimited effectiveness in older adultsAssociated with serious problems, such as: delirium, GI bleeding, falls, and fracturesLess is more approachBeers List is now an important quality measure with CMS, Medicare Part D, NCQA, HEDIS, and PQACMS centers for Medicare and Medicaid ServicesNCQA National Committee for Quality AssuranceHEDIS Healthcare Effectiveness Data and Information SetPQA Pharmacy Quality Alliance6

Potentially Inappropriate Medications and Classes to AVOID in Older Adults

New AdditionsMegestrolGlyburideSliding-scale insulinPotentially Inappropriate Medications and Classes to Avoid in Older Adults with Certain Diseases and Syndromes

New AdditionsThiazolidinediones or Glitazones with CHFAcetylcholinesterase inhibitors with history of syncopeSSRIs with falls and fracturesMedications to be used in CAUTION with older adults

New AdditionsAnti-thrombotics caution in 75 years and olderRemoved Since 2003 (Last Update)

ConclusionsPreviously, ~40% of patient have received 1 or more drugs from this listNew update is based upon methods for determining best-practice guidelinesThis list should serve as a guideline and risk vs. benefit should always be assessedThis list is not meant to supersede clinical judgment

ConclusionsPrescribing and managing disease states should be individualizedIf a medication on the list cannot be avoided and the physician feels it is necessary, the patient should be closely monitored for ADEsRegular updates of this list allow for the evidence for medications to be assessed regularly, making it more relevant and sensitive to patient outcomesReferenceAmerican Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Journal of American Geriatric Society, 2012.