AGS Beers Criteria for Potentially High Risk Medication Use in Older Adults This clinical tool , furnished from The American Geriatrics Society ( AGS 2015 Beers Criteria ), has been developed to assist health care providers in improving medication safety in older adults . The Beers Criteria catalogues medications that may cause adverse drug events in older adults due to their pharmacologic properties and the physiologic changes of aging . Each criterion is rated ( quality of evidence and strength of evidence ) using the American College of Physicians ’ Guideline Grading System , which is based on the GRADE scheme developed by Guyatt et . al . The full document together with accompanying resources can be viewed online at www . american geriatrics . org .
The goal of this clinical tool is to improve the care of older adults by reducing their exposure to potentially high risk medications .
• This should be viewed as a guide for identifying medications for which the risks of use in older adults outweigh the benefits .
• These criteria are not meant to be applied in a punitive manner .
• This list is not meant to supersede clinical judgment or an individual patient ’ s values and needs . Prescribing and managing disease conditions should be individualized and involve shared decision-making .
• These criteria also underscore the importance of using a team approach to prescribing and the use of non-pharmacological approaches and of having economic and organizational incentives for this type of model .
The criteria are not applicable in all circumstances ( e . g ., patients receiving palliative or hospice care ). If a clinician is not able to find an alternative and chooses to continue to use a drug on this list for an individual patient , designation of the medication as potentially inappropriate can serve as a reminder for close monitoring so that the potential for an adverse drug effect can be incorporated into the medical record and prevented or detected early .
Table 1 : 2015 AGS Beers Criteria for Potentially High Risk Medication use in Older Adults
Organ System / Therapeutic Category / Drug ( s )
Anticholinergics ( excludes TCAs )
First-generation antihistamines ( as single agent or as part of combination products ):
� Brompheniramine
� Carbinoxamine
� Chlorpheniramine
� Clemastine
� Cyproheptadine
� Dexbrompheniramine
� Dexchlorpheniramine
� Dimenhydrinate
� Diphenhydramine ( oral )
� Doxylamine
� Hydroxyzine
� Meclizine
� Promethazine
� Tripolidine
Antiparkinson agents
� Benztropine ( oral )
� Trihexyphenidyl
Avoid .
Recommendation , Rationale Quality of Evidence ( QE ) & Strength of Recommendation ( SR )
Highly anticholinergic ; clearance reduced with advanced age , and tolerance develops when used as hypnotic ; increased risk of confusion , dry mouth , constipation , and other anticholinergic effects / toxicity .
Use of diphenhydramine in situations such as acute treatment of severe allergic reaction may be appropriate .
QE = Moderate SR = Strong
Avoid .
Not recommended for prevention of extrapyramidal symptoms with antipsychotics ; more effective agents available for treatment of Parkinson ’ s disease .
QE = Moderate SR = Strong
Potential Alternatives
For allergies : Second-generation antihistamines :
� Loratadine
� Cetirizine
� Aazelastine , nasal solution
� Olopatadine , nasal solution
Levodopa / Carbidopa
Antispasmodics Atropine ( excludes ophthalmic ) Belladonna alkaloids Clidinium-chlordiazepoxide Dicyclomine Hyoscyamine Propantheline Scopolamine
Avoid . Highly anticholinergic , uncertain effectiveness .
QE = Moderate SR = Strong
Bowel Regimen
Use of High Risk Medications in the Elderly - 2