Editorialists describe the history and development of the Beers criteria and other measures of potentially inappropriate prescribing to older adults. “Over the past more than three decades, the Beers criteria have resonated deeply with clinicians and researchers,” write the authors. “They have evolved in terms of the older adults that they apply to, the depth of leadership of the initiative, and the methodology being used. Yet, they have remained consistent in their intent, which is to improve the way we prescribe for older adults.”
The 2023 American Geriatrics Society Beers Criteria, published earlier this year, “provide an explicit list of potentially inappropriate medications that should be avoided by older adults in most circumstances, with the exception of those receiving hospice and end-of-life care,” write the editorialists. “Since the Beers criteria were first published, a series of explicit and implicit tools have been developed internationally to guide prescribing for older adults. Explicit tools include expert consensus lists and measures of an individual’s overall medication burden. One of the best known expert consensus lists is the STOPP/START criteria, first published in 2008 as primarily an Irish consensus, and later broadened to include experts from 10 European countries in the third edition published in 2023. This expert consensus list covers potentially inappropriate medications, analogous to the Beers criteria, as well as potential prescribing omissions. Explicit measures that consider an older adult’s total exposure to drugs with pharmacological effects that impair physical and cognitive function include the Drug Burden Index. This is a pharmacological measure of an individual’s exposure to drugs with anticholinergic and sedative effects. Several other anticholinergic risk scales have been developed to measure burden based on different pharmacologic considerations.”