July CPE Article 2019 American Geriatrics Society Beers Criteria® Update Authors: Mark Huffmyer, PharmD, BCGP, BCACP, CACP; Ana Vo, PharmD Candidate; Mary Sau, PharmD Candidate; Bao-Han Nguyen, MS, PharmD Candidate; Lynne Eckmann, PharmD, BCGP; Daniela C. Moga, MD, PhD The authors declare that there are no financial relationships that could be perceived as real or apparent conflicts of interest. Universal Activity # 0143-0000-20-007-H01-P &T 1.0 Contact Hours (0.1 CEU) Expires 8/31/23
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Learning Objectives: At the conclusion of this Knowledge-based article, the reader should be able to: Define Beers Criteria® and its application. Identify common medications to avoid or flagged with caution based on the 2019 American Geriatrics Society Beers Criteria®. Evaluate updates from the 2015 American Geriatrics Society Beers Criteria®. Illustrate Beers Criteria® to optimize medication regimens in older adults by evaluating risks and benefits of medications and reducing adverse drug events. Set (HEDIS), National Committee for Quality Assurance (NCQA), and Pharmacy Quality Alliance (PQA) have From 2010 to 2050, it is projected that the older adult populaadapted Beers Criteria® with the same goal to improve pation (i.e., 65 years and older) will grow from 8% to 21% of the tient outcomes. world population. With an increasingly aging population, clinical consequences arise as a result of the prevalence of After Beers’ death, the Beers Criteria® was adopted by the comorbidities and decreased functional ability of the populaAGS, who published the first update in 2012. Since then, the tion. Older adults are more likely to experience polypharmaAGS has updated Beers Criteria® every three years under the cy and associated inappropriate prescribing of medications. consideration of an interdisciplinary expert panel, including Drug utilization reviews are tools that pharmacists can utilize representatives from CMS, NCQA and PQA; the latest such to identify potentially inappropriate medications (PIMs) and update was published in 2019.6 Beers Criteria® compiles a list their adverse drug reactions. Although PIMs are not a definiof PIMs including (1) PIMs in older adults, (2) drug-disease tive contraindication for medication use in older adults, they or drug-syndrome interactions, (3) drugs to be used with caumay worsen a patient’s existing disease and require individution in older adults, (4) drug-drug interactions that should be alized evaluation of risks and benefits for decision-making. avoided in older adults, (5) medications that should be avoidInappropriate medications causing adverse drug reactions can ed or dose-adjusted with varying levels of kidney function in have significant clinical consequences; adverse drug reactions older adults, (6) drugs with harmful adverse effects, and (7) are among the most common causes of iatrogenic harm and medications with strong anticholinergic properties. Rationale, mortality. recommendation, quality of evidence, and strength of recommendation are included. Quality of evidence is evaluated on In order to identify harmful medications and standardize pre- an ACP- and GRADE-based approach and rated as low, scribing guidelines for older populations over 65 years of age, moderate, or high. Strength of evidence is rated as strong or Mark H. Beers, MD, developed the Beers Criteria® in 1991. weak based on whether risk “clearly” or “may not” outweigh 6 It has become the most widely used and longest-standing re- benefits. source by clinicians in the United States of America to identi- How to Utilize the Beers Criteria® fy PIMs in older adults. As drug experts and liaisons, pharmacists and pharmacy technicians in clinical and community In 2015, AGS released a set of principles to guide the application of the Beers Criteria® and optimize its implementation settings have the most important role in drug utilization reby clinicians. The first principle states that medications inview. Beers Criteria® can serve as a useful tool in helping pharmacists and pharmacy technicians be actively involved in cluded in the Beers Criteria® should be considered potentialthe healthcare team to help identify medication-related prob- ly inappropriate, not definitely inappropriate.9 Drugs should lems and optimize treatment to improve outcomes. Regulato- be evaluated to ensure benefit over harm, but they are not ry bodies such as the Center for Medicaid and Medicare Ser- contraindicated in the elderly population. Furthermore, to vices (CMS), Healthcare Effectiveness Data and Information help with clinical decision-making, each criterion has a raBackground
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|8| Kentucky Pharmacists Association | July/August 2020
