The American Geriatrics Society (AFS) has released its second updated and expanded Beers Criteria, including alternative therapies for potentially inappropriate medications and more detailed guidance on best practices for implementing AGS recommendations.

Over 40 potentially problematic medications or classes of medications were identified and organized across five lists. Some updates include two lists covering potentially inappropriate medications for older adults or for those with specific conditions, and an additional list details specific medications that should be used only with considerable caution. New additions to the 2015 AGS Beers Criteria also include a specific list of medication combinations that may lead to harmful interactions and a separate synthesis of some medications that should be avoided or dosed differently for people with poor kidney function.

The AGS Beers Criteria now includes:

  • Separate guidance on avoiding 13 combinations of medications known to cause harmful “drug-drug interactions.
  • A specific list of prescriptions to avoid or adjust based on how well a person’s kidneys function.
  • Three new medications and two new “classes” of medications added to warning lists for most older people or for those with specific health concerns, such as proton-pump inhibitors.
  • Removal of several medications from the AGS Beers Criteria because they are no longer available or because the underlying condition or concerns they address is no longer limited to older people, like medications for those with chronic constipation.
  • Endorsement of “avoiding antipsychotics for behavioral problems” altogether unless behavior modification has failed or the older adult poses a physical threat to self or others.