Use of High Risk Medications in the Elderly
Beers Criteria
The Beers Criteria are the most widely-cited criteria used to assess high risk drug prescribing .
A comprehensive , systematic review and grading of the evidence on drug-related problems and adverse drug events was used to develop the criteria .
The intention of the criteria include improving the selection of prescription drugs by clinicians and patients , evaluating patterns or drug use within populations , educating clinicians and patients on proper drug usage , and evaluating health outcome , quality of care , cost , and utilization data .
Reducing prescriptions of high-risk drugs in the elderly can reduce the costs associated with the harm from medications ( e . g ., hospitalizations from drug toxicity ). These medications are associated with serious problems such as :
• delirium
• gastrointestinal bleeding
• falls
• fractures
Adverse drug events result in four times as many hospitalizations in older adults , as compared to younger adults .
Considerations for Prescribing
• The avoidance of high risk medications
• Appropriate use of indicated medications
• Monitoring for side effects and drug level
• Avoidance of drug-drug interactions
• Involvement of the patient and integration of patient values all factor into the overall quality of drug prescribing
• The patient ’ s life expectancy and goals
Appropriate Prescribing in the Elderly : Questions to Ask
• Is there an indication for the drug ?
• Is the medication effective for the condition ?
• Is the dosage correct ?
• Are the directions correct ?
• Are the directions practical ?
• Are there significant drug-drug interactions ?
• Are there significant drug-disease / condition interactions ?
• Is there unnecessary duplication with other drugs ?
• Is the duration of the therapy acceptable ?
• Is this drug the least expensive alternative compared with others of equal usefulness ?
Onset of New Symptoms
For any new symptom , consider adverse drug events .
• Consider non-pharmacologic approaches .
• Substitute with safer alternatives .
• Reduce the dose .
• Simplify the dosing schedule .
Prescribing Cascades
• Prescribing cascades occur when a new drug is prescribed to treat symptoms arising from an unrecognized adverse drug event related to an existing therapy .
• The patient is then at risk for developing additional adverse drug events from the new therapy . Periodic review of medication lists can minimize this risk .
This reference tool outlines the suggestions of Mount Carmel Health Partners for this medical condition and is based upon the referenced best practices . It is not intended to serve as a substitute for professional medical judgment in the diagnosis and treatment of a particular patient . Decisions regarding care are subject to individual consideration and should be made by the patient and treating physician in concert .
December 2016