From The Hartford Institute for Geriatric Nursing, New York University, College of Nursing

Best Practices in Nursing

Care to Older Adults
general assessment series
Issue Number 16, Revised 2013 Editor-in-Chief: Sherry A. Greenberg, PhD(c) MSN, GNP-BC
New York University College of Nursing
The 2012 American Geriatrics Society Updated Beers Criteria
for Potentially Inappropriate Medication Use in Older Adults
By: Sheila Molony Sheila Molony, PhD, RN, GNP-BC, Connecticut Community Care, Inc. and
Sherry A. Greenberg, PhD(c), MSN, GNP-BC, The Hartford Institute for Geriatric Nursing
WHY: The 2012 American Geriatrics Society (AGS) Updated Beers Criteria are designed to reduce older adults drug-related problems
including, but not limited to exposure to potentially inappropriate medications, drug-disease interactions, and medications that warrant
extra caution in the older adult population. Older adults experience the highest prevalence of adverse drug events (Tach, Snnichsen, &
Ashcroft, 2011) and many of these events are avoidable.
BEST TOOL: The American Geriatrics Society Updated Beers Criteria (AGS, 2012). The AGS Updated Beers Criteria include three main
categories: (1) potentially inappropriate medications and classes to avoid in older adults; (2) potentially inappropriate medications and
classes to avoid in older adults with certain diseases and syndromes that the drugs listed can exacerbate; and (3) medications to be used
with caution in older adults.
TARGET POPULATION: Older adults > 65 years of age in all ambulatory and institutional care settings.
VALIDITY AND RELIABILITY: The AGS Updated Beers Criteria was developed using an evidence-based approach which substantially
followed the Institute of Medicine standards for evidence and transparency, including a peer and public review of the draft (Fick & Semla,
2012). The process included a rigorous systematic review of over 2,169 citations. Each recommendation included a rationale and rating of
the quality of evidence and strength of recommendation, using the American College of Physicians Guideline Grading System. Consensus
was achieved among an interdisciplinary panel of 11 experts in geriatric care and pharmacotherapy. Studies will be needed to support
predictive validity.
STRENGTHS AND LIMITATIONS: The AGS Updated Beers Criteria increase awareness of inappropriate medication use in older adults
(Fick & Semla, 2012), as well as assist nurses 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.
FOLLOW-UP: The AGS Updated Beers Criteria should be used to inform clinical practice, evaluation, education, research, and policy
to improve the safety and quality of medication prescribing for older adults. The AGS Updated Beers Criteria do not substitute for
professional judgment or the need to tailor care to each patients individual needs, goals, and unique situation.
Consideration should be given that the AGS Updated Beers Criteria may be used in conjunction with other criteria, such as The Screening
Tool of Older Persons Potentially Inappropriate Prescriptions and Screening Tool to Alert Doctors to the Right Treatment (STOPP/START
criteria), to best guide health care providers through the medication decision-making process (Fick & Semla, 2012).
An expert panel process supported by AGS will allow for a more frequent monitoring and update of the AGS Beers Criteria.
MORE ON THE TOPIC:
The American Geriatrics Society 2012 Beers Criteria Update Expert Panel. (2012). American Geriatrics Society Updated Beers Criteria for Potentially
Inappropriate Medication Use in Older Adults. Journal of the American Geriatrics Society, 60, 616631. doi: 10.1111/j.1532-5415.2012.03923.x. Available
online at http://www.americangeriatrics.org/les/documents/beers/2012BeersCriteria_JAGS.pdf.
Best practice information on care of older adults and best practices to guide non-pharmacologic intervention: www.ConsultGeriRN.org.
Barry, P.J., Gallagher, P., Ryan, C., & OMahony, D. (2007). START (screening tool to alert doctors to the right treatment)--an evidence-based screening tool
to detect prescribing omissions in elderly patients. Age and Ageing, 36(6), 632-638.
Fick, D.M., & Resnick, B. (2012). 2012 Beers Criteria update. How should practicing nurses use the Criteria? Journal of Gerontological Nursing, 38(6),
3-5. doi: 10.3928/00989134-20120517-01. Available online at http://www.healio.com/nursing/journals/JGN/%7B2E316F56-184D-4886-
B01CCC42AEBBA8D9%7D/2012-Beers-Criteria-Update-How-Should-Practicing-Nurses-Use-the-Criteria.
Fick, D.M., & Semla, T.P. (2012). 2012 American Geriatrics Society Beers Criteria: New year, new criteria, new perspective. Available online at: http://www.
americangeriatrics.org/les/documents/beers/Perspective_JAGS.pdf.
Hamilton, H., Gallagher, P., Ryan, C., Byrne, S., & OMahony, D. (2011). Potentially inappropriate medications dened by STOPP criteria and the risk of
adverse drug events in older hospitalized patients. Archives of Internal Medicine, 172(11), 1013-1019.
Marcum, Z.A. & Hanlon, J.T. (2012). Commentary on the new American Geriatric Society Beers Criteria for Potentially Inappropriate Medication Use in
Older Adults. The American Journal of Geriatric Pharmacotherapy, 10(2), 151-159. doi: 10.1016/j.amjopharm.2012.03.002
Resnick, B., & Fick, D.M. (2012). 2012 Beers Criteria update. How should practicing nurses use the Criteria? Geriatric Nursing, 33(4),
253-255doi:10.1016/j.gerinurse.2012.06.001
Tach, S.V., Snnichsen, A., & Ashcroft, D.M. (2011). Prevalence of adverse drug events in ambulatory care: A systematic review. Annals of
Pharmacotherapy, 45(7-8), 977-989. doi: 10.1345/aph.1P627.
and The American Geriatrics Society
Permission is hereby granted to reproduce, post, download, and/or distribute, this material in its entirety only for not-for-prot educational purposes only, provided that
The Hartford Institute for Geriatric Nursing, New York University, College of Nursing is cited as the source. This material may be downloaded and/or distributed in electronic format,
including PDA format. Available on the internet at www.hartfordign.org and/or www.ConsultGeriRN.org. E-mail notication of usage to: hartford.ign@nyu.edu.
Best Practices in Nursing
Care to Older Adults
A series provided by The Hartford Institute for Geriatric Nursing,
New York University, College of Nursing
EMAIL hartford.ign@nyu.edu HARTFORD INSTITUTE WEBSITE www.hartfordign.org
CLINICAL NURSING WEBSITE www.ConsultGeriRN.org
general assessment series
The 2012 American Geriatrics Society Updated Beers Criteria
for Potentially Inappropriate Medication Use in Older Adults
Primary source: The American Geriatrics Society 2012 Beers Criteria Update Expert Panel (2012),
American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use
in Older Adults. Journal of the American Geriatrics Society, 60, 616631. doi: 10.1111/j.1532-
5415.2012.03923.x. Available online at: http://www.americangeriatrics.org/les/documents/
beers/2012BeersCriteria_JAGS.pdf
The above article contains the following AGS 2012 Beers Criteria tables:
Table 2: 2012 American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication
Use in Older Adults (pp. 4-8 in the above pdf article)
Table 3: 2012 American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication
Use in Older Adults Due to DrugDisease or DrugSyndrome Interactions That May Exacerbate
the Disease or Syndrome (pp. 9-11 in the above pdf article)
Table 4: 2012 American Geriatrics Society Beers Criteria for Potentially Inappropriate Medica
tions to Be Used with Caution in Older Adults (p. 12 in the above pdf article)
Other important AGS 2012 Beers Criteria resources:
Fick, D.M., & Semla, T.P. (2012). 2012 American Geriatrics Society Beers Criteria: New Year, New
Criteria, New Perspective. Available online at: http://www.americangeriatrics.org/les/docu
ments/beers/Perspective_JAGS.pdf.
The AGS Beers Criteria 2012 Pocket Card available at: http://www.americangeriatrics.org/les/
documents/beers/PrintableBeersPocketCard.pdf
Based on the AGS Geriatrics Review Syllabus (GRS): A Core Curriculum in Geriatric Medicine,
7th Edition, the GRS Teaching Slides Website includes downloadable slide presentations in Mi
crosoft

PowerPoint

on the AGS Beers Criteria 2012. The Beers Criteria Teaching Slides are
available at: http://teachingslides.americangeriatrics.org/sample.asp
For more information, please visit the AGS Beers Criteria 2012 Clinical Practice Website at:
http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guide-
lines_recommendations/2012
Acknowledgement: The Hartford Institute for Geriatric Nursing at New York University College of Nursing acknowl-
edges that this Try This

issue was developed in conjunction with the American Geriatrics Society. The collaboration
is greatly appreciated as we aim to improve care to older adults.