Pharmacology in Geriatric Rehabilitation
K. Rao Poduri in Geriatric Rehabilitation, 2017
Given the complexity of geriatric care, three tools have been developed to assist with identifying and preventing the use of potentially inappropriate medications. The American Geriatric Society Beers’ Criteria is the national standard for quality indicators and geriatric clinical care. These evidence-based criterion were updated in 2015 and now include medications requiring dosage adjustment in renal impairment and select drug–drug interactions known to cause harm in seniors (15). It is important to remember that the Beers Criteria are meant to guide clinicians in selecting medications for senior patients. The Quality of Evidence and Recommendations are based on the general elderly population and may not apply to a specific patient in a special population such as traumatic brain injury.
Cardiovascular drug therapy in the elderly
Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich in Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Acknowledging the limitation of this first set of criteria, Beers updated and expanded it to encompass elderly patients who are in the ambulatory setting, as well as medications that should be avoided in elderly known to have certain conditions (186). In 2011, the American Geriatrics Society (AGS) has taken on the responsibility of updating and maintaining the Beers Criteria. Since then, two updates have been released by the AGS, one in 2012 and the other in 2015 (187,188). These criteria are intended for use in populations ≥65 years of age in all ambulatory, acute, and institutionalized settings (with the exception of hospice and palliative care) in the United States (188). Table 4.10 lists selected antithrombotics and cardiovascular medications that should be avoided by the elderly according to the 2015 AGS Beers Criteria. Table 4.11 lists selected medications recognized by the 2015 AGS Beers Criteria as potentially inappropriate to use in the elderly due to drug-cardiovascular disease or drug-cardiovascular syndrome interactions. Table 4.12 lists cardiovascular or hemostasis drugs that should be avoided or necessitate a dosage reduction in elderly with renal impairment according to the 2015 AGS Beer Criteria. Although these criteria serve as useful tools for assessing the quality of prescribing to the elderly, they do not identify all cases of potentially inappropriate prescribing. In fact, these criteria may identify appropriate prescribing as inappropriate at times. The latter case may particularly be likely when physicians and pharmacists carefully adjust medication regimens for specific needs of individual patients (186).
Development of palliative medicine in the United Kingdom and Ireland
Eduardo Bruera, Irene Higginson, Charles F von Gunten, Tatsuya Morita in Textbook of Palliative Medicine and Supportive Care, 2015
36 Twillman RK, Manetto C. Concurrent psychotherapy and pharmacotherapy in the treatment of depression and anxiety in cancer patients. Psychooncology 1998;7(4):285-290. 37 Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults: Results of a U.S. consensus panel of experts. Arch Intern Med 2003; 163(22): 2716-2724.
Psychotropic Use among Older Adults Living at Home: Use of the Anatomical Therapeutic Chemical (ATC) Drug Classification System and Beers Criteria®
Published in Issues in Mental Health Nursing, 2021
G. H. Gunnarsdottir, MS, RN, A. K. Sigurdardóttir, PHD, RN, K. Ólafsson, MA, G. K. Kristofersson, PHD, RN, PMKNP-BC
Treatment of older adults with prescription medications requires skillful and careful prescribers since changes in pharmacokinetics and pharmacodynamics due to age make older adults especially sensitive to side effects (Noble, 2003). Inappropriate medication prescribing is considered a public health issue for older adults due to its association with morbidity and mortality resulting from adverse medication reactions (Fialová et al., 2005; Hart et al., 2019; O’Mahony & Gallagher, 2008). Consequently, criteria have been developed for prescribing appropriate medications for this age group. One of the most acknowledged of these is the American Geriatrics Society (AGS) Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, or the Beers Criteria. The Beers Criteria include five main categories and list potential inappropriate medications that should be avoided or used with caution with older adults (≥65 years) or older adults with certain conditions to reduce adverse medication reactions and polypharmacy in adults (AGS, 2019). The Beers Criteria, first published in 1991, were developed due to inappropriate medication use in nursing homes in the USA (AGS, 2019; Beers et al., 1991). The most recently updated Beers Criteria from 2019 include 30 mediations or medication categories that should be avoided in general for older adults and 40 other medications or medication categories that should be used with caution in this population and in some cases avoided all together (AGS, 2019).
Analysis of the relationship between patients’ fear of falling and prescriber acceptance of community pharmacists’ recommendations
Published in Cogent Medicine, 2019
Tenley Brown, Jessica M. Robinson, Chelsea P. Renfro, Susan J. Blalock, Stefanie Ferreri
While a wide range of factors may contribute to an individual’s risk of falling, evidence suggests that medication use may play a significant role. A meta-analysis by Woolcott et al. (2009) found a significant relationship between risk of falls and the use of antidepressants, benzodiazepines, sedatives/hypnotics, antipsychotics, and other medication classes. Accordingly, many of these medications are included in the American Geriatrics Society’s Beers’ Criteria for Potentially Inappropriate Medication Use in Older Adults (Samuel, 2015). These medications are often referred to in the literature as “high-risk medications” due to their increased risk of adverse events, including falls, in older adults. One study showed that medication management services performed by general practitioners in Australia decreased the risk of falls in older adults by 39% (Pit et al., 2007).
Prescribing issues in elderly individuals living with HIV
Published in Expert Review of Clinical Pharmacology, 2019
Catia Marzolini, Françoise Livio
The Beers criteria was developed in 1991 by Mark H. Beers, an American geriatrician [70] and updated in 1997 [81], 2003, 2012, 2015 and 2019 [20]. The criteria are established from meta-analyses, systematic reviews, and expert consensus panel and include [20]: medications to avoid in most older adults (e.g. first-generation antihistamines due to their highly anticholinergic effects)medications to avoid in older adults with specific diseases or syndromes (e.g. non-steroidal anti-inflammatory drugs (NSAIDs) in case of heart failure due to their potential to promote fluid retention and exacerbate heart failure)medications to be used with caution (e.g. dabigatran in patients ≥75 years or with creatinine clearance below 30 mL/min due to increased risk of bleeding)potentially severe DDIs (e.g. lithium and ACE inhibitors due to risk of lithium accumulation)medications to avoid or requiring dosage adjustments based on the patient’s kidney function (e.g. pregabalin in case of creatinine clearance <60 mL/min due to increased risk of CNS adverse reactions)
Related Knowledge Centers
- Adverse Drug Reaction
- Anticholinergic
- Deprescribing
- Diphenhydramine
- Drug Interaction
- Geriatrics
- Palliative Care
- Polypharmacy
- Risk–Benefit Ratio
- Evidence-Based Medicine