Beers Criteria for Potentially Inappropriate Medication Use in Older AdultsPart II: 2002 Criteria Considering Diagnoses or Con

Best Practices in Nursing Care for Older Adults fromThe Hartford Institute for Geriatric Nursing New York University, College of Nursing

Issue Number 16.2, Revised 2008
Series Editor: Marie Boltz, PhD, APRN, BC, GNP
Managing Editor: Sherry A. Greenberg, MSN, APRN, BC, GNP
New York University College of Nursing

by Sheila Molony, PhD, RN, BC, GNP, Yale University School of Nursing
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WHY: Recently published studies confirm that inappropriate medication use remains a serious problem for the elderly (Bonk, et al, 2006; Lau, et al, 2005). Nursing knowledge of potentially inappropriate medications will enable attentive monitoring for adverse effects, and increase awareness of disease and condition-specific medication concerns in older adults.

BEST TOOL: The 2002 Criteria for Potentially Inappropriate Medication Use in Older Adults (Fick, et al, 2003) update the 1997 Beers Criteria, and identify medications noted by an expert consensus panel to have potential risks that outweigh potential benefits. The criteria provide an outcome severity rating (high vs. low) and a brief summary of the prescribing concerns. Try This: Part I presents the criteria independent of diagnosis or condition; Try This: Part II presents the criteria considering diagnosis or medical condition. Try This: Part II focuses on Table 2 from the 2002 Criteria. It lists 20 diseases or conditions and medications to be avoided in older adults with these conditions. Sixty-six of these potentially inappropriate drugs were considered by the expert panel to have adverse outcomes of high severity. New conditions and diagnoses that were addressed in this update included depression, cognitive impairment, Parkinson disease, anorexia, and malnutrition, syndrome of inappropriate antidiuretic hormone secretion, and obesity.

TARGET POPULATION: The criteria apply to the general population of adults older than 65 years of age. There may be additional medications that are inappropriate for a significantly older or frailer population.

VALIDITY AND RELIABILITY: The criteria were developed using a modified Delphi method to achieve consensus among 12 experts in geriatrics and/or pharmacology. The criteria have been used to screen populations for possible medication-related problems. Use of inappropriate medications has been associated with negative outcomes (Fu, et al, 2004; Lau, et al, 2005; Perri, et al, 2005). Additional studies are needed to support predictive validity and address potential confounding variables such as severity of underlying illness (Lau, et al, 2005; Zuckerman, et al, 2006).

STRENGTHS AND LIMITATIONS: The criteria will assist nurses to identify patients who may benefit from monitoring or medication review. The criteria do not identify all cases of potentially inappropriate prescribing or medication-associated adverse events, and do not address polypharmacy or underuse of helpful medications. The criteria are designed for population-based screening and are not intended to substitute for professional judgment regarding the individualized needs of particular older adults.

FOLLOW-UP: Nurses may use the criteria to increase awareness of medications that may increase risk for adverse drug reactions. Nurses, primary care providers and pharmacists may collaborate to optimize individualized medication regimes and provide appropriate clinical monitoring and education. The suggested references provide further information on medication risk and older adults.

MORE ON THE TOPIC:
Best practice information on care of older adults: www.ConsultGeriRN.org.

Beers, M.H. (1997). Explicit criteria for determining potentially inappropriate medication use by the elderly. Archives of Internal Medicine, 157, 1531-1536.

Bonk, M.E., Krown, H., Matuszewski, K., & Oinonen, M. (2006). Potentially inappropriate medications in hospitalized senior patients. American Journal of Health-System Pharmacy, 63(12), 1161-1165.

Fick, D.M., Cooper, J.W., Wade, W.E., Waller, J.L., Maclean, J.R., & Beers, M.H. (2003). Updating the Beers Criteria for potentially inappropriate medication use in older adults: Results of a US consensus panel of experts. Archives of Internal Medicine, 163(22), 2716-2724.

Fu, A.Z., Liu, G.G., & Christensen, D.B. (2004). Inappropriate medication use and health outcomes in the elderly. JAGS, 52(11), 1934-1939.

Lau, D.T., Kasper, J.D., Potter, D.E., Lyles, A., & Bennett, R.G. (2005). Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents. Archives of Internal Medicine, 165(1), 68-74.

Perri, M. III, Menon, A.M., Deshpande, A.D., Shinde, S.B., Jiang, R., & Cooper, J.W., Cook, C.L., Griffin, S.C., & Lorys, R.A. (2005). Adverse outcomes associated with inappropriate drug use in nursing homes. Annals of Pharmacotherapy, 39(3), 405-411.

Zuckerman, I.H., Langenberg, P., Baumgarten, M., Orwig, D., Byrns, P.J., & Simoni-Wastila, L., & Magaziner, J. (2006). Inappropriate drug use and risk of transition to nursing homes among community-dwelling older adults. Medical care, 44(8), 722-730.

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