The 2023 AGS Beers Criteria represent an expert consensus, offering guidance for potentially inappropriate medications (PIMs) in older adults.
This updated resource aids healthcare professionals in optimizing medication regimens and promoting safer prescribing practices.
What are the Beers Criteria?
The Beers Criteria are explicitly defined lists of potentially inappropriate medications (PIMs) for older adults. Developed by the American Geriatrics Society (AGS), these criteria aren’t absolute contraindications, but rather flags for cautious clinical evaluation. They highlight medications generally avoided due to higher risk of adverse effects in this population.
The criteria categorize PIMs based on conditions where alternatives are typically preferred, or where the risk outweighs the benefit. The 2023 update builds upon previous versions, incorporating new evidence and refining existing recommendations. It’s a dynamic tool, continually evolving to reflect the latest understanding of geriatric pharmacotherapy. The goal is to enhance patient safety and optimize medication use in older individuals.
Purpose and Importance of the Update
The 2023 update to the AGS Beers Criteria addresses the evolving landscape of medication use and the growing population of older adults. Many older patients take multiple medications, increasing the risk of drug interactions and adverse events. This update aims to minimize harm by providing clinicians with current, evidence-based guidance on potentially inappropriate medications.
The revisions incorporate new research, clarify existing recommendations, and expand the list of medications requiring dose adjustments based on renal function – notably adding Baclofen and NSAIDs. Furthermore, the release of the AGS Beers Criteria Alternatives List supports safer prescribing by offering viable treatment options. Ultimately, the update strives to improve the quality of care for older adults.
Target Audience: Healthcare Professionals
The AGS Beers Criteria are primarily intended for use by healthcare professionals involved in the care of older adults. This includes physicians, pharmacists, nurses, and other clinicians who prescribe, dispense, or monitor medications. The criteria serve as a valuable tool for comprehensive medication review and deprescribing efforts.
While not rigid rules, the Beers Criteria offer guidance to facilitate informed clinical decision-making. Professionals should consider individual patient factors, such as comorbidities and functional status, alongside the criteria; The goal is to optimize medication regimens, minimize potential harms, and enhance the overall well-being of older patients. Effective implementation requires ongoing education and a commitment to patient-centered care.
Key Changes in the 2023 Update
The 2023 update includes new medications, modifications to existing entries, and clarified rationales, particularly regarding renal function adjustments for drugs like baclofen and rivaroxaban.
New Medications Added to the List
The 2023 AGS Beers Criteria update incorporated several new medications deemed potentially inappropriate for older adults. While a comprehensive list requires consulting the full criteria, key additions focus on minimizing risks associated with polypharmacy and age-related physiological changes. Notably, certain nonsteroidal anti-inflammatory drugs (NSAIDs) received increased scrutiny, leading to their inclusion under specific circumstances.
The expert panel carefully reviewed emerging evidence to identify medications with limited benefit or substantial harm potential in geriatric populations. This proactive approach aims to enhance patient safety and optimize medication regimens. The additions aren’t blanket prohibitions, but rather flags for careful consideration and individualized assessment. Healthcare professionals should always weigh the risks and benefits within the context of each patient’s unique health profile.
Modifications to Existing Medication Entries
The 2023 update to the Beers Criteria didn’t solely focus on adding new medications; significant modifications were also made to existing entries. These revisions primarily aimed to clarify language, refine rationale, and reflect the latest clinical evidence. Specifically, adjustments were made to the sections concerning trimethoprim-sulfamethoxazole and rivaroxaban.
These changes weren’t about fundamentally altering the appropriateness assessment, but rather ensuring greater precision and usability for healthcare providers. The panel sought to eliminate ambiguity and provide clearer guidance on when a medication might be considered inappropriate. This iterative process demonstrates the Beers Criteria’s commitment to remaining a dynamic and responsive clinical tool, continually evolving with advancements in geriatric pharmacology and patient care.
Clarification of Rationale for Inclusion
A key focus of the 2023 Beers Criteria update was enhancing the transparency surrounding why specific medications are flagged as potentially inappropriate for older adults. The expert panel meticulously reviewed the evidence base supporting each inclusion, striving for greater clarity in the rationale provided. This isn’t simply about listing drugs to avoid, but about educating clinicians on the risks and benefits within the context of aging.
The goal is to empower informed decision-making, allowing healthcare professionals to understand the specific vulnerabilities of older patients and tailor treatment plans accordingly. Clear rationale fosters appropriate clinical judgment, moving beyond rote memorization towards a nuanced understanding of geriatric pharmacotherapy. This commitment to transparency strengthens the Criteria’s utility as an educational resource.
Potentially Inappropriate Medications (PIMs) by Class
The Beers Criteria categorizes PIMs by pharmacological class, including anticholinergics, first-generation antihistamines, and benzodiazepines, aiding targeted medication review for older adults.
Anticholinergics
Anticholinergic medications, widely used for various conditions, pose significant risks for older adults due to their association with adverse cognitive outcomes and other complications. The 2023 Beers Criteria explicitly identifies several anticholinergics as potentially inappropriate in this population. These drugs can contribute to delirium, falls, constipation, urinary retention, and even dementia over time.
Healthcare professionals are urged to carefully review patient medication lists for anticholinergic burden, considering both prescribed and over-the-counter medications. Alternatives with lower anticholinergic effects should be prioritized whenever clinically feasible. Deprescribing anticholinergics, when appropriate, can significantly improve patient safety and quality of life. A comprehensive assessment of benefits versus risks is crucial before initiating or continuing anticholinergic therapy in older adults.
First-Generation H1 Antihistamines
First-generation H1 antihistamines, like diphenhydramine and chlorpheniramine, are flagged as potentially inappropriate medications (PIMs) in the 2023 Beers Criteria due to their substantial anticholinergic effects and associated risks in older adults. These risks include sedation, dizziness, confusion, falls, and impaired cognitive function. Their use is particularly concerning given the availability of safer alternatives.
Healthcare providers should actively avoid prescribing these agents for older patients and explore second-generation antihistamines, which have a lower propensity for adverse effects. When first-generation antihistamines are unavoidable, the lowest effective dose should be used for the shortest duration possible. Thorough patient education regarding potential side effects is also essential to mitigate risks and promote informed decision-making.
Benzodiazepines
Benzodiazepines consistently appear on the Beers Criteria list as potentially inappropriate medications (PIMs) for older adults, reflecting significant concerns regarding adverse effects. These include increased risk of falls, hip fractures, cognitive impairment, and paradoxical reactions like agitation. Long-term use is strongly discouraged due to the potential for dependence and withdrawal symptoms.
The 2023 update reinforces the recommendation to avoid benzodiazepines in older individuals whenever possible. When use is unavoidable – for example, in acute situations – the lowest effective dose should be prescribed for the shortest duration. Non-pharmacological alternatives and other anxiolytic or hypnotic agents with improved safety profiles should be prioritized. Careful monitoring and gradual tapering are crucial if discontinuation is necessary.
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Nonsteroidal Anti-inflammatory Drugs (NSAIDs) are frequently listed as potentially inappropriate medications (PIMs) in the Beers Criteria, particularly for older adults. This designation stems from their association with serious adverse events, including gastrointestinal bleeding, cardiovascular events (like heart attack and stroke), and kidney dysfunction. The risk is amplified in individuals with pre-existing conditions.
The 2023 update continues to advise caution with NSAID use in this population. Topical NSAIDs are generally preferred over systemic formulations to minimize systemic exposure and reduce risk. If systemic NSAIDs are necessary, the lowest effective dose should be used for the shortest possible duration, alongside gastroprotective agents when appropriate. Alternative pain management strategies should be explored proactively.
Medications Requiring Dose Adjustments
Certain medications necessitate careful dose adjustments based on renal function in older adults, as highlighted in the 2023 Beers Criteria updates, including baclofen and NSAIDs.
Renal Function Considerations
The 2023 Beers Criteria significantly emphasize renal function when prescribing for older adults. Declining kidney function is common with age, impacting drug metabolism and excretion, potentially leading to accumulation and toxicity. Table 6 specifically details agents requiring dose adjustments based on estimated glomerular filtration rate (eGFR).
This update adds baclofen and NSAIDs to the list of medications needing renal consideration. Healthcare professionals must carefully assess eGFR before initiating or continuing these drugs. Modifications to trimethoprim-sulfamethoxazole and rivaroxaban clarify the rationale for dosage adjustments in patients with impaired renal function, ensuring safer prescribing practices and minimizing adverse effects in this vulnerable population.
Baclofen and Renal Adjustment
The 2023 Beers Criteria update now includes baclofen in Table 6, highlighting the necessity for dose adjustments based on renal function. Baclofen, a muscle relaxant, is primarily eliminated by the kidneys; Consequently, impaired renal function can lead to baclofen accumulation, increasing the risk of adverse effects like sedation, weakness, and confusion in older adults.
Healthcare providers should carefully assess a patient’s eGFR before prescribing baclofen and regularly monitor renal function during treatment. Dosage reductions are crucial for individuals with reduced kidney function to maintain therapeutic benefits while minimizing potential harm. This addition underscores the importance of personalized medication management in geriatric care.
Trimethoprim-Sulfamethoxazole Dosage
The 2023 Beers Criteria update clarifies recommendations regarding trimethoprim-sulfamethoxazole (TMP-SMX) dosage in older adults. While not newly added as a PIM, the update emphasizes careful consideration of renal function when prescribing this antibiotic. TMP-SMX is eliminated renally, and diminished kidney function can elevate drug levels, increasing the risk of adverse effects like hyperkalemia and acute kidney injury.
The update reinforces the need for healthcare professionals to assess eGFR and adjust TMP-SMX dosage accordingly. Avoiding prolonged use and considering alternative antibiotics when appropriate are also encouraged. This clarification aims to optimize antibiotic stewardship and minimize potential harm in a vulnerable population.
Rivaroxaban Dosage Adjustments
The 2023 Beers Criteria update addresses rivaroxaban, an oral anticoagulant, highlighting the importance of dosage adjustments based on renal function in older adults. Similar to trimethoprim-sulfamethoxazole, rivaroxaban is primarily eliminated through the kidneys, making individuals with impaired renal function susceptible to increased bleeding risk with standard doses.
The update clarifies the rationale for considering reduced rivaroxaban dosages in patients with reduced kidney function, emphasizing a careful benefit-risk assessment. Healthcare providers are encouraged to evaluate eGFR and tailor the dosage to minimize adverse events. This adjustment aims to maintain effective anticoagulation while safeguarding against potentially dangerous bleeding complications in older patients.
Alternatives to PIMs
The AGS Beers Criteria now includes an alternatives list, supporting healthcare professionals in identifying safer and more appropriate treatment options for older adults.
Safer Treatment Options
Identifying safer treatment options is a core component of utilizing the 2023 AGS Beers Criteria effectively. The updated criteria emphasize a shift towards medications with lower risks for older adults, considering their increased vulnerability to adverse drug events. This involves carefully evaluating alternatives that address the patient’s condition without the potential harms associated with potentially inappropriate medications (PIMs).
Healthcare professionals are encouraged to explore non-pharmacological interventions whenever feasible, alongside considering medications with more favorable risk-benefit profiles. The AGS Beers Criteria Alternatives List, released in July 2025, provides a valuable resource for navigating these choices, offering practical guidance on substituting PIMs with safer alternatives tailored to individual patient needs and circumstances.
AGS Beers Criteria Alternatives List
The American Geriatrics Society (AGS) released a dedicated Alternatives List to directly support the 2023 Beers Criteria, aiming to facilitate safer prescribing for older adults. This clinical resource, published in July 2025 (DOI: 10.1111/jgs.19500), doesn’t simply identify problematic medications; it proactively suggests viable alternatives.
The list is designed to help healthcare professionals quickly identify more appropriate treatment options, categorized by the PIMs they replace. It considers factors like efficacy, safety profiles, and cost-effectiveness, offering practical guidance for individualized patient care. Utilizing this list streamlines the deprescribing process and promotes a more holistic approach to medication management in the elderly population, ultimately enhancing patient outcomes.
Focus on Individualized Patient Care
The 2023 AGS Beers Criteria emphasize that the list represents guidance, not rigid rules. Applying these criteria necessitates a thorough understanding of each patient’s unique clinical profile. Factors like co-morbidities, functional status, and goals of care must heavily influence medication decisions.
Simply identifying a PIM isn’t enough; clinicians must assess the risk-benefit ratio for that specific patient. Alternatives should be considered, but only after careful evaluation of their suitability. Shared decision-making with the patient and their caregivers is crucial, ensuring alignment with their preferences and values. The Beers Criteria serve as a tool to enhance, not replace, clinical judgment and personalized care plans.
Using the Beers Criteria in Practice
Regular medication review, incorporating the 2023 AGS Beers Criteria, is essential for identifying potentially inappropriate prescriptions and optimizing patient outcomes.
Regular Medication Review
Consistent and systematic medication review is a cornerstone of safe and effective geriatric care, and the 2023 AGS Beers Criteria serve as a valuable tool in this process. Healthcare professionals should routinely assess older adults’ medication lists, comparing them against the Beers Criteria to identify potentially inappropriate medications (PIMs).
This review should encompass all medications – including prescription drugs, over-the-counter remedies, and supplements – to gain a comprehensive understanding of the patient’s pharmacological profile. The goal isn’t simply to eliminate medications, but to carefully evaluate the risk-benefit ratio for each drug in the context of the individual patient’s health status, comorbidities, and functional abilities. A pocket guide version of the criteria facilitates quick reference during clinical encounters.
Deprescribing Strategies
Deprescribing – the planned reduction or cessation of medications – is a crucial component of implementing the 2023 AGS Beers Criteria. It’s rarely a simple process and requires a thoughtful, patient-centered approach. Abrupt discontinuation can be harmful; therefore, gradual tapering is often preferred, especially for medications with long half-lives or potential withdrawal symptoms.
Healthcare providers should engage in shared decision-making with patients, explaining the rationale for deprescribing and addressing any concerns. Utilizing a Beers Criteria pocket guide can aid in quick identification of PIMs. Monitoring for symptom recurrence or adverse effects during and after tapering is essential. Documenting the deprescribing plan and rationale ensures continuity of care and facilitates communication among the healthcare team.
Patient Education and Shared Decision-Making
Effective implementation of the 2023 AGS Beers Criteria hinges on robust patient education and truly shared decision-making. Patients must understand why a medication is considered potentially inappropriate for them, avoiding jargon and focusing on benefits versus risks. A Beers Criteria pocket guide can be a visual aid during discussions.
Providers should actively solicit patient preferences and concerns, acknowledging their expertise regarding their own bodies and experiences. Presenting alternative treatment options, as highlighted in the AGS Beers Criteria Alternatives List, empowers patients to participate in their care. Open communication fosters trust and improves adherence to deprescribing plans. Ultimately, collaborative decisions lead to better outcomes and increased patient satisfaction;
Resources and Further Information
Access the 2023 AGS Beers Criteria and related resources, including the Alternatives List, via the American Geriatrics Society website.
Relevant DOIs: 10.1111/jgs.18372 & 10.1111/jgs.19500.
American Geriatrics Society Website
The American Geriatrics Society (AGS) website serves as the central hub for accessing the comprehensive 2023 Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. This invaluable resource provides detailed information regarding potentially harmful medications, categorized for easy reference by healthcare professionals. You’ll find the complete criteria list, alongside supporting documentation explaining the rationale behind each inclusion.
Furthermore, the AGS website hosts the newly released Beers Criteria Alternatives List, designed to assist clinicians in identifying safer and more appropriate treatment options for their older patients. The site also features educational materials, implementation tools, and updates on relevant research. Direct access to the criteria and related publications can be found using the provided DOIs: 10.1111/jgs.18372 and 10.1111/jgs.19500.
DOI: 10.1111/jgs.18372
This DOI links directly to the original publication announcing the 2023 update to the American Geriatrics Society (AGS) Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Released on May 4, 2023, this landmark update represents a significant advancement in geriatric pharmacotherapy. The publication details the rigorous review process undertaken by an interprofessional expert panel, evaluating evidence published since the previous iteration of the criteria.
Researchers and clinicians can access the full article to understand the specific changes made, including new medications added to the list and modifications to existing entries. It provides a detailed explanation of the rationale behind each inclusion, ensuring transparency and informed clinical decision-making. This resource is crucial for anyone seeking a comprehensive understanding of the updated Beers Criteria.
DOI: 10.1111/jgs.19500
This DOI directs users to the American Geriatrics Society’s (AGS) newly released Beers Criteria Alternatives List, published on July 23, 2025. This valuable clinical resource is specifically designed to support healthcare professionals in identifying safer and more appropriate treatment options for older adults. Recognizing that simply identifying potentially inappropriate medications (PIMs) isn’t enough, the AGS provides practical alternatives.
The list offers guidance on substituting PIMs with medications or therapies that pose a lower risk of adverse effects in this vulnerable population. It emphasizes individualized patient care, acknowledging that the best approach varies depending on a patient’s specific health status and needs. Accessing this resource empowers clinicians to optimize medication regimens and enhance patient outcomes.
