Meredith Cook Mercer COPHS August, 2012

1. American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults Meredith Cook Mercer COPHS August, 2012

2. Beers Criteria • AGS and interdisciplinary panel of 11 experts in geriatrics and pharmacotherapy • 53 medications or medication classes • Three categories: • Potentially inappropriate medications and classes to AVOID in older adults • Potentially inappropriate medications and classes to AVOID in older adults with certain diseases and syndromes • Medications to be used in CAUTION in older adults

3. Beers Criteria • This update will allow for: • Closer monitoring of medication use • Real-time e-prescribing and interventions to decrease adverse drug eventsin older adults • Better patient outcomes

4. Medication Related Problems • Common, costly, and often preventable • 27% of ADE’s in primary care and 42% of ADE’s in LTC were PREVENTABLE • Most problems occurred at ordering and monitoring stages of therapy • Total healthcare expenditures related to use of PIMs was $7.2 billion in 2000/2001 Medical Expenditure Panel Survey

5. Medication Related Problems • Explicit Criteria – unfavorable balance of risk vs. benefit – consider alternate therapy • Implicit Criteria – therapeutic duplication and drug-drug interactions • Both of these have been taken into consideration when compiling the Beers List

6. PIMs • Limited effectiveness in older adults • Associated with serious problems, such as: delirium, GI bleeding, falls, and fractures • “Less is more” approach • Beers List is now an important quality measure with CMS, Medicare Part D, NCQA, HEDIS, and PQA

8. Potentially Inappropriate Medications and Classes to AVOID in Older Adults

16. New Additions • Megestrol • Glyburide • Sliding-scale insulin

17. Potentially Inappropriate Medications and Classes to Avoid in Older Adults with Certain Diseases and Syndromes

23. New Additions • Thiazolidinediones or Glitazones with CHF • Acetylcholinesterase inhibitors with history of syncope • SSRIs with falls and fractures

24. Medications to be used in CAUTION with older adults

25. New Additions • Anti-thrombotics – caution in 75 years and older

26. Removed Since 2003 (Last Update)

27. Conclusions • Previously, ~40% of patient have received 1 or more drugs from this list • New update is based upon methods for determining best-practice guidelines • This list should serve as a guideline and risk vs. benefit should always be assessed • This list is not meant to supersede clinical judgment

28. Conclusions • Prescribing and managing disease states should be individualized • If a medication on the list cannot be avoided and the physician feels it is necessary, the patient should be closely monitored for ADEs • Regular updates of this list allow for the evidence for medications to be assessed regularly, making it more relevant and sensitive to patient outcomes

29. Reference • American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Journal of American Geriatric Society, 2012.