Beers Criteria Panel Member Discusses 2019 Update

Following the 2019 Beers Criteria for Potentially Inappropriate Medication Use in Older Adults update, Annals of Long-Term Care spoke with Nicole J. Brandt, PharmD, MBA, BCGP, BCPP, FASCP. Dr Brandt was a panel member who helped decide the new 2019 updates. She explains how the panel identified the medication or medication classes added to the list in the new update and how the update better addresses patient safety.

Please tell us a little about yourself as a panelist.

I am a professor of pharmacy practice and science as well as executive director of the Peter Lamy Center on Drug Therapy and Aging at the University of Maryland. I have expanded geriatric training opportunities, including the geriatrics/palliative care pathway, ASHP-accredited geriatrics residency, and 2-year post PharmD Fellowship.  I have been a practicing pharmacist in geriatrics for nearly 20 years and a nationally known leader in geriatric pharmacy. I have focused my career on improving medication safety in older adults.  Recent research funding has afforded the opportunity to lead the work with beneficiaries, caregivers and case managers nationally to gauge aspects of the Medicare Part D Medication Therapy Management service that are of value to help propose future program modifications to the Centers of Medicare and Medicaid Services. I have worked on various interdisciplinary teams across numerous practice settings, and am currently leading initiatives to improve services to help older adults with multiple co-morbidities at the MedStar Center for Successful Aging. As one of the authors of the 2012, 2015 and 2018 American Geriatrics Society Beer’s Criteria, I have learned a great deal from this process and how this work impacts the lives of older adults and the medications they may be prescribed. Furthermore, I am a past President and Board Chairman of American Society of Consultant Pharmacists.

Please tell us the major updates to the 2019 AGS Beers Criteria.

Across its five lists, the 2019 AGS Beers Criteria® includes:

• 30 individual medications or medication classes to avoid for most older people.
  • For example, glimepiride—a medication to control high blood sugar for people with type 2 diabetes—is new to the AGS Beers Criteria® in 2019. Evidence reviewed by the AGS panel suggests glimepiride can result in severe and prolonged hypoglycemia (low blood sugar), a serious concern for older adults.
• 40 medications/medication classes to use with caution or avoid when living with certain diseases/ conditions.
  • For example, the AGS Beers Criteria® cautions against the use of daily aspirin in people age 70 and older who have not had a heart attack, stroke, or other condition involving blocked arteries. This is because the risk of bleeding may exceed the potential benefits of taking aspirin to prevent future heart attacks or strokes.
• Several changes to medications previously identified as potentially inappropriate. Twenty-five medications or medication classes were dropped outright from the last update to the AGS Beers Criteria® (2015), while several others were moved to new categories or had guidance revised.
  • The medicines that were dropped from the AGS Beers Criteria® were mostly removed on the basis of being used infrequently and not because new evidence shows they are now safe and effective.

Can you highlight how the panel identified the medication or medication classes added to the list?

Our panel of 13 experts convened and reviewed more than 1,400 clinical trials and research studies from a pool of more than 17,000 articles published between 2017 and the last AGS Beers Criteria® update (2015). Given the intention of the AGS Beers Criteria® to serve as a tool for the care of older adults specifically, we focused on research addressing individual medications/medication classes or conditions with a focus on “adverse drug events” or “adverse drug reactions.”

Though not an exhaustive compendium of all medications potentially to avoid or use with caution, the AGS Beers Criteria® reflects our panel’s review of literature for medications with a specific impact on older adults.

How do these updates impact medication safety for older adults? 

Avoiding potentially inappropriate medications is an important strategy for improving care and reducing unnecessary harm. Explicit lists of these medications—like the American Geriatrics Society (AGS) Beers Criteria®—have a track-record for reducing inappropriate prescribing, decreasing risks for adverse events, and promoting high-quality, person-centered care.

It’s also critically important to remember that medications noted as potentially inappropriate in the AGS Beers Criteria® are just that—potentially inappropriate. They merit special scrutiny but should not be misconstrued as universally unacceptable in all cases or for all people. The caveats and rationales informing AGS Beers Criteria® recommendations are as important as the recommendations themselves, therefore, since they can help healthcare professionals know why medications are included on the list, and how approaches to prescribing should be adjusted accordingly.

How will these new updates improve overall patient care? 

The AGS Beers Criteria® should serve as a starting point for a comprehensive process of identifying and improving medication use for individual patients based on their own needs and preferences when it comes to care. In this way, they can help improve care and reduce unnecessary harms by helping older adults avoid pharmacologic treatments that may not be the safest or most effective options for older adults in particular.

What are important takeaways from these updates for both health care professionals and patients?

Avoiding potentially inappropriate medications is an important strategy for improving care and reducing unnecessary harm. Explicit lists of these medications—like the American Geriatrics Society (AGS) Beers Criteria®—have a track-record for reducing inappropriate prescribing, decreasing risks for adverse events, and promoting high-quality, person-centered care.

Medications noted as potentially inappropriate in the AGS Beers Criteria® are just that—potentially inappropriate. They merit special scrutiny but should not be misconstrued as universally unacceptable in all cases or for all people.

Resources for healthcare professional (available from GeriatricsCareOnline.org) and older adults/caregivers (available from HealthinAging.org) can help both groups work together to support safe, effective, person-centered care.

Is there anything else you would like to add? 

It takes a team to improve medication safety in older adults and it is imperative that we engage the patient and their caregiver in this process. That is why AGS continues to strive to make tools like the Beers criteria be available and a great resource for all involved in improving care for older adults.