Every few years the American Geriatrics Society publishes a list of what they term to be "potentially inappropriate medication for use in older adults." It's called the Beers Criteria® and it's widely used by geriatricians, pharmacists, researchers and other health practitioners. Unfortunately it's not as widely known or used by consumers.
We think it's a fantastic reference guide for the general population. We don't recommend you use the information to override a prescription your doctor has made for you. Rather, we suggest it be used as a resource to ask your doctor why the decision was made and if the decision remains appropriate.
The Beers Criteria® includes 30 classes of medications to be avoided in older adults and 40 medications or medication classes that should be avoided or used with caution by certain older adults with certain ailments. It also covers medication combinations that should be avoided and medications that should be avoided for those with kidney issues. You can get the entire list here.
We're going to focus on some of the more widely prescribed medications that are found on the Beers Criteria® list, the concerns with those medications and some of the alternatives you can explore to give you the same benefits without the risk. Please remember, there are exceptions to every rule and there may be appropriate reasons to be taking some of the medications even if its recommended most people avoid them. This is meant as a guide to discuss your medication regimen with your doctor.
|Class of Drugs Listed as Inappropriate||Medications Listed as Inappropriate||Sample Brand Names||Concern||Alternatives|
Antihistamines (anti-allergy medication)
|Clearance reduced with advanced age, risk of confusion, dry mouth, constipation||
Saline nasal rinse
Steroid nasal sprays such as fluticasone (Flonase)
Allergy products such as:
|Risk of cognitive impairment, delirium, falls, fractures and motor vehicle crashes in older adults||
|Risk of delirium, falls, fractures, increased emergency room visits, hospitalizations, motor vehicle crashes||Ask your doctor about non-medication sleep hygiene techniques|
|First (conventional) generation
Second (atypical) generation
|Increased risk of stroke, and greater rates of cognitive decline and mortality in people with dementia.||
For delirium - antipsychotics (e.g., haloperidol, quetiapine), short term, restricted use.
|Pain Medications (NSAIDs)||Aspirin >325 mg/day
|Increased risk of gastrointestinal bleeding or peptic ulcer disease. Can also increase blood pressure and induce kidney injury. Risks can be associated with duration and dosage.||
Topical capsaicin products
|Highly anticholinergic, sedating and cause orthostatic hypotension||
|High rate of addiction, tolerance and greater risk of overdose at low dosages||
How To Use The Beers Criteria®
With over 90% of adults over the age of 65 taking at least one medication and 40% taking at least five medications, prescriptions and over the counter drugs are a common part of most seniors' lives. The Beers Criteria® list of potentially inappropriate medications for older adults is a great tool to make you a better informed patient. But it should never be used in isolation to make a decision on your own without first consulting your doctor. It's a starting point to begin a conversation with your doctors that ensures you get the best medical outcome with the least amount of risk.
It's important to remember that the Beers Criteria does not address all medication risks. It does not necessarily identify all inappropriate medications, over-prescribing, or the under use of certain helpful medications. It does not address medication adherence or medication compliance. Moreover, despite being inappropriate for most people, some medications may be the best alternative in some situations for some people. Lastly, the Beers Criteria list does not apply to seniors in hospice or palliative care.