Polypharmacy Factors Pt 3

This is #3 in the Polypharmacy series about why we should be concerned with seniors taking so many pills:   What is Beers List of Potentially Inappropriate Medications 

What is Beers List and why is it important?

Beers List, or Beers Criteria (named after the geriatrician Dr. Beers), was first published in 1991 and described drugs seniors should avoid because the potential for harm outweighed any potential benefit the drug was supposed to have.  Since then, there have been several updates, most recently in 2012 by the American Geriatrics Society.

The List is important because multiple studies have shown these drugs are associated with poorer  outcomes, such as:  increased hospitalizations and death rates; more risk of falling, fractures, confusion, and depression; and increased need for assistance in ADL’s [Activities of Daily Living – dressing, toileting, walking, eating, bathing].  State agencies and Medicare use the List to monitor the quality of care provided in nursing homes:  any patient on one of these drugs must have good documentation justifying why.

What drugs are included?

The List now includes 53 medications or medication classes, divided into three categories:

1) drugs to avoid in all older adults;

2) those to avoid if you have certain diseases that the drugs can make worse; and

3) those drugs which may be used but only with great caution.

I need to emphasize that the List only suggests drugs that are “potentially inappropriate”.  Since everyone reacts differently, there may be situations where (a) a senior really needs to take it because other drugs haven’t worked, or (b) they’ve been on that one for years, it works, and they’ve have had no, or minimal, side-effects.  The decision to take the drug must be a shared one between patient and doctor.

The List’s importance is in helping us be more aware of possible side-effects so that you can avoid high-risk drugs hopefully; and then if you are having a bothersome symptom, it helps guide your choice when stopping one (or more) drugs, rather than add another prescription to treat the side-effect.  If your health depends on the drug, your physician may be able to prescribe a substitute with fewer side-effects.

The next three articles will highlight a sample of drugs in each of the three categories.