Week 6 - Beer's Criteria

Beers Criteria - Benefits (2)

- Use of many medications included in the AGS Beers Criteria® has declined - Increased appreciation of special considerations that should be applied when prescribing for older adults

Beers Criteria - Challenges (3)

- Many clinicians misunderstand the purpose of the criteria, mistakenly believing that the criteria judge all uses of the listed drugs to be universally inappropriate - Health systems have often reinforced this perception, implementing quality improvement and decision support systems that implicitly consider any use of these medications to be problematic - Some prior authorization programs built around the AGS Beers Criteria® have been misapplied by payors and/or misinterpreted by the prescribing clinician

Beers criteria updates 1. Table 8 2. Table 9 3. Table 10

1. - Medications/Criteria Removed Since 2015 American Geriatrics Society Beers Criteria 2. - Medications/Criteria Added Since 2015 American Geriatric Society Beers Criteria 3. - Medications/Criteria Modified Since 2015 American Geriatric Society Beers Criteria

7 Key Principles to guide optimal use of the AGS Beers Criteria Most important take-home message is this: Use clinical common sense! - The AGS Beers Criteria® are intended tosupport, not contradict, common sense andgood clinical care

1. Medications in the 2019 AGS Beers Criteria® arepotentially inappropriate, not definitely inappropriate 2. Read the rationale and recommendations statements for each criterion. The caveats and guidance listed there are important. 3. Understand why medications are included in the 2019 AGS Beers Criteria®, and adjust your approach to those medications accordingly. 4. Optimal application of the 2019 AGS Beers Criteria® involves ... offering safer non-pharmacologic and pharmacologic therapies. 5. The 2019 AGS Beers Criteria® should be a starting point for a comprehensive process of identifying and improving medication appropriateness and safety. 6. Access to medications included in the 2019 AGS Beers Criteria® should not be excessively restricted by prior authorization and/or health plan coverage policies. 7. The 2019 AGS Beers Criteria® are not equally applicable to all countries.

Beers criteria categories 1. Table 2 2. Table 3 3. Table 4 4. Table 5 5. Table 6

1. Table 2 - Potentially inappropriate medication use in older adults 2. Table 3 - Potentially inappropriate medications due to drug-disease or drug-syndrome interactions that may exacerbate the disease or syndrome 3. Table 4 - Potentially inappropriate medications to be used with caution in older adults 4. Table 5 - Potentially clinically important drug-drug interactions that should be avoided in older adults 5. Table 6 - Medications that should be avoided or have their dosage reduced with varying levels of kidney function in older adults