Potentially Inappropriate Medications for Use in Older Adults: Beers Criteria (2023 American Geriatrics Society Guidelines)

Abstract

INTRODUCTION. Pharmacotherapy in elderly and senile patients is associated with multimorbidity and polypharmacy and can lead to adverse drug reactions (ADRs). The growth of the world’s population over 60 makes the practical application of the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, the key recommendations to optimise prescribing in the geriatric population, increasingly important.AIM. This study aimed to review the history of the Beers criteria, the main changes in the updated 2023 version, and national and international publications on the practical experience of using the criteria in healthcare settings.DISCUSSION. The criteria for assessing the rationality of pharmacotherapy in older patients were developed by Mark Beers in 1991. His recommendations have been regularly reviewed and updated by a panel of experts from the American Geriatrics Society (AGS); version 7 has been in effect since 2023. The criteria are designed to support pharmacotherapy decision making for adults 65 years old and older in all ambulatory, acute, and institutionalised settings of care, except hospice and end-of-life care settings. The criteria are organised into 5 categories: 1) medications that should be avoided in all older adults; 2) medications considered potentially inappropriate in patients with certain diseases or syndromes; 3) medications that should be used with caution; 4) medications that are potentially inappropriate due to the risk of clinically significant drug–drug interactions; 5) medications that should be avoided or require dosage reduction in patients with impaired renal function. Medicines with pronounced anticholinergic effects are categorised as a separate class. The criteria are based on expert grading of the quality of evidence and strength of recommendations. Compared with the previous version (2019), the updated AGS Beers Criteria® (2023) changed the most in terms of recommendations for anticoagulants and sulfonylureas. According to the results of this review, the AGS Beers Criteria® are actively used in healthcare practice in Russia and abroad to reduce the undesirable effects of potentially inappropriate medication use in elderly patients by optimising the selection of medicines and treatment regimens; to train healthcare providers and patients in the principles of rational pharmacotherapy; to reduce the cost of pharmacotherapy; and to assess the quality of medical care.CONCLUSIONS. The AGS Beers Criteria® are an effective tool for identifying potentially inappropriate medications in prescribed therapy and selecting appropriate alternatives. Their practical application in healthcare settings can reduce ADRs, hospital admissions, and mortality rates in elderly and senile patients.