American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults

Abstract

The American Geriatrics Society (AGS) Beers Criteria® (AGS Beers Criteria®) for Potentially Inappropriate Medication (PIM) Use in Older Adults are widely used by clinicians, educators, researchers, healthcare administrators, and regulators. Since 2011, the AGS has been the steward of the criteria and has produced updates on a 3‐year cycle. The AGS Beers Criteria® is an explicit list of PIMs that are typically best avoided by older adults in most circumstances or under specific situations, such as in certain diseases or conditions. For the 2019 update, an interdisciplinary expert panel reviewed the evidence published since the last update (2015) to determine if new criteria should be added or if existing criteria should be removed or undergo changes to their recommendation, rationale, level of evidence, or strength of recommendation. J Am Geriatr Soc 67:674–694, 2019.

Characteristics of Older Adults Who Were Early Adopters of Medical Cannabis in the Florida Medical Marijuana Use Registry

“…In older adults, the estimated prevalence of at least one potential drug-drug interactions in current regimens is 50% and is as high as 80% in certain clinical groups, with up to 1 in 4 patients at risk for ≥4 drug-drug interactions [34][35][36][37]. Many prescription drugs have unclear risk/benefit profiles in older users and have led to clinical tools (e.g., Beers Criteria, STOPP/START, anticholinergic burden scales) [38][39][40][41] to avoid certain medications or avoid specific drug-disease interactions in order to minimize ADEs. In older adults, ADEs disproportionately contribute to severe health outcomes.…”

Decision Making for Older Adults With Multiple Chronic Conditions: Executive Summary for the American Geriatrics Society Guiding Principles on the Care of Older Adults With Multimorbidity

“…Use patients' priorities as the focus of decision making and communication ▪ Frame the pros and cons of treatment and care options around each patient's priorities, not just disease-based tradeoffs. 47 63,64 Avoid medication cascades 65 Consider whether treatments may be contributing to symptoms and perform serial trials of discontinuing possible contributing treatments Discontinue or decrease treatments no longer indicated or needed [66][67][68][69][70][71][72][73][74][75] Review and adjust self-management tasks 72,76 • Consider whether the patient has advanced illness or limited life expectancy that affects benefits and harms of treatments Consider health trajectory and time to benefit for preventive interventions Explain cessation of screening and prevention as a shift in priorities and use positive messaging 52,59,77…”

Practical use of Direct Oral Anti Coagulants (DOACs) in the older persons with atrial fibrillation.

“…Apixaban has been suggested as a reasonable first choice either in older patients and in subjects with chronic renal failure [63]. The recently updated 2019 American Geriatrics Society Beers criteria recommend a cautious use of dabigatran and rivaroxaban in AF patients aged ≥ 75 years because of greater risk of gastrointestinal bleeding [65]. In a recent report from the Fit-fOR-The-Aged (FORTA) classification (evaluating benefit, risk and appropriateness of drugs for older patients in everyday clinical settings) [66,67], apixaban was labelled A among OATs, meaning it was seen as the drug with the most favorable risk/benefit ratio in older patients [68].…”