Fifty-three medications or medication classes encompass the final updated 2012 AGS Beers Criteria, which are divided into three categories (Table 2, Table 3 and Table 4). Tables were constructed and organized according to major therapeutic classes and organ systems.

 

Table 2 shows the 34 potentially inappropriate medications and classes to avoid in older adults. Notable new additions include megestrol, glyburide, and sliding-scale insulin.

 

Table 3 summarizes potentially inappropriate medications and classes to avoid in older adults with certain diseases and syndromes that the drugs listed can exacerbate. Notable new inclusions are thiazolidinediones or glitazones with heart failure, acetylcholinesterase inhibitors with history of syncope, and selective serotonin reuptake inhibitors with falls and fractures.

 

Table 4 lists medications to be used with caution in older adults. Fourteen medications and classes were categorized. Two of these involve recently marketed antithrombotics for which early evidence suggests caution for use in adults aged 75 and older.

 

Table 5 is a summary of medications that were moved to another category or modified since the last update, and Table 6 and Table 7 summarize medications that were removed or added since the last update. 

 

Table 8 includes a list of the antipsychotics included in the statements.

 

Table 9 is the list of anticholinergic medications to be avoided in older adults compiled from drugs rated as having strong anticholinergic properties in the Anticholinergic Risk Scale (Rudolph JL) Anticholinergic Drug Scale (Carnahan RM, 2006) and Anticholinergic Burden Scale (Boustani M, 2008).

 

 

Strengths and Limitations :

 

The AGS Updated Beers Criteria increase awareness of inappropriate medication use in older adults (Fick DM, 2012), as well as assist nurses (Resnick B, 2012) and interprofessional team members in medication reviews and ongoing monitoring.

Additionally, they inform prescribers and clinical decision support providers as they work to improve patient outcomes.

The AGS Updated Beers Criteria do not identify all cases of potentially inappropriate prescribing and do not address overtreatment (e.g. excessive duration of therapy), drug-drug interaction, underuse of helpful medicines, or alternatives to medications associated with adverse drug events in older adults.