2023 AGS Beers Criteria®: Guiding Safe Medication Use for Older Adults

1. AGS Beers Criteria® 2023 Update: The AGS Beers Criteria® is regularly updated to identify potentially inappropriate medications for older adults, with the latest update released in 2023.

2. Addition of New Medications: The 2023 update includes the addition of medications found to pose an increased risk of adverse effects or lack evidence of effectiveness in older adults.

3. Removal of Certain Medications: Some medications have been removed from the list based on new evidence suggesting their safety and effectiveness in older adults.

4. Importance of AGS Beers Criteria®: The Beers Criteria plays a crucial role in promoting safe medication use in older adults by helping healthcare providers make informed prescribing decisions.

5. Key Recommendations:

   • Avoid primary use of aspirin for cardiovascular health in older adults.

   • Prefer direct oral anticoagulants (DOACs) over warfarin for atrial fibrillation or venous thromboembolism, with apixaban being the preferred DOAC.

   • Caution in the use of antipsychotic medications in older adults, particularly outside FDA-approved indications.

   • Avoid anticholinergics, antipsychotics, benzodiazepines, and non-benzodiazepine sleeping medications in dementia patients.

   • Evaluate NSAIDs carefully for older adults due to risks of gastrointestinal issues and cardiovascular disease.

   • Avoid specific medications like sulfonylureas, long-term proton pump inhibitors, first-line digoxin use, and nitrofurantoin in certain situations.

6. Conclusion: Healthcare professionals must understand and apply the 2023 Beers Criteria to enhance the quality of care and prioritize the well-being of older patients by ensuring the safe and appropriate use of medications.

   
   

As we age, our bodies undergo various changes that can affect how we metabolize and respond to medications. This is why it is crucial for healthcare providers to be aware of the potential risks and benefits of different medications in older adults. To assist healthcare professionals in making informed decisions, the American Geriatrics Society (AGS) periodically updates the AGS Beers Criteria®, a list of potentially inappropriate medications for older adults.

What's New in the 2023 Update?

The most recent update to the AGS Beers Criteria® was released in 2023 and includes several important changes. One notable update is the addition of new medications to the list of potentially inappropriate medications in older adults. These medications have been found to pose an increased risk of adverse effects or lack evidence of effectiveness in older adults.

Another significant change in the 2023 update is the removal of certain medications from the list. This decision was based on new evidence that suggests these medications may be safe and effective when used appropriately in older adults.

Why is the AGS Beers Criteria® Important?

The AGS Beers Criteria® plays a vital role in promoting safe medication use in older adults. By identifying potentially inappropriate medications, healthcare providers can make informed decisions when prescribing medications for their older patients. This helps to minimize the risk of adverse events and improve overall patient safety.

Older adults are more susceptible to the adverse effects of medications due to age-related changes in their body's ability to metabolize drugs. They are also more likely to have multiple chronic conditions and be taking multiple medications, which increases the risk of drug interactions and adverse effects.

Key Recommendations

The 2023 Beers Criteria presents several noteworthy recommendations regarding the use of specific medications in older adults. Let's delve into these recommendations:

1. Aspirin for Cardiovascular Health

For primary prevention of atherosclerotic cardiovascular disease, the use of aspirin in older adults can pose a higher risk than benefit due to the increased susceptibility to major bleeding. As a result, it's advisable to avoid aspirin for primary prevention in this age group. However, aspirin remains a valuable option for secondary prevention in individuals with established cardiovascular disease.

2. Warfarin vs. DOACs

In cases of atrial fibrillation or venous thromboembolism, it's preferable to steer clear of warfarin, if possible. The reason lies in the higher risk of major bleeding, particularly intracranial bleeding, associated with warfarin when compared to direct oral anticoagulants (DOACs). Among DOACs, rivaroxaban should be avoided due to its higher bleeding risk, making apixaban the preferred choice. Nonetheless, if a patient is well controlled on warfarin, the option of continuing this treatment can be considered.

3. Antipsychotics Use

The Beers Criteria emphasizes the cautious use of antipsychotic medications, both first- and second-generation, including aripiprazole, haloperidol, olanzapine, quetiapine, risperidone, and others. These drugs should be avoided unless there are FDA-approved indications such as schizophrenia, bipolar disorder, and adjuvant treatment of depression. The use of antipsychotics in older adults can elevate the risk of stroke, heart attack, and mortality. The guidance acknowledges that treatment of agitated dementia is a challenging issue, and these medications should only be considered if behavioral interventions have proven ineffective.

4. Medications for Dementia

In patients with dementia, the use of anticholinergics, antipsychotics, and benzodiazepines should be avoided whenever possible. Older adults are more sensitive to the effects of these medications, leading to a higher risk of cognitive impairment, delirium, falls, fractures, and motor accidents. The same concerns extend to non-benzodiazepine sleeping medicines known as "Z-drugs."

5. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs, commonly used in medical practices, should be evaluated carefully when considering their use in older adults. These drugs carry risks that are sometimes underestimated, including the development of upper gastrointestinal ulcers with bleeding and an increased risk of renal impairment and cardiovascular disease.

6. Other Medications to Avoid

The Beers Criteria also includes a list of other medications that should be avoided in older adults whenever possible. This list covers:

• Sulfonylureas: Due to their high risk for hypoglycemia, older adults should opt for short-acting sulfonylureas, such as glipizide, if needed.

• Proton Pump Inhibitors: Long-term use should be avoided whenever possible.

• Digoxin: It should not be the first-line treatment for atrial fibrillation or heart failure, as decreased renal clearance in older adults can lead to toxic levels of digoxin.

• Nitrofurantoin: This drug should be avoided when the patient's creatinine clearance is below 30 or for long-term suppressive therapy.

• Combining Medications with High Anticholinergic Effects: Medications like scopolamine, diphenhydramine, oxybutynin, and cyclobenzaprine, which have high anticholinergic side effects, should be used with caution.

Conclusion

Understanding and applying the American Geriatrics Society's 2023 Beers Criteria is essential for healthcare professionals involved in the care of older adults. These guidelines provide valuable insights into the safe and appropriate use of medications in this vulnerable population. By following these recommendations, healthcare providers can enhance the quality of care and prioritize the well-being of older patients.

Reference Article

By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023; 71(7): 2052-2081. doi:10.1111/jgs.18372

Related

https://healthnewstrend.com/how-intermittent-fasting-can-help-slow-alzheimers-disease

Medical Disclaimer

The information on this website is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.