{"id":8218,"date":"2025-10-01T12:59:55","date_gmt":"2025-10-01T16:59:55","guid":{"rendered":"https:\/\/www.silvercentury.org\/?p=8218"},"modified":"2025-10-01T12:59:55","modified_gmt":"2025-10-01T16:59:55","slug":"the-beers-criteria-what-patients-need-to-know","status":"publish","type":"post","link":"http:\/\/78.142.243.82\/~silvercentury\/2025\/10\/the-beers-criteria-what-patients-need-to-know\/","title":{"rendered":"The Beers Criteria: What Patients Need to Know"},"content":{"rendered":"

Before she landed in the hospital, Wilma Jones (not her real name) was living independently and generally managing well, despite some mild cognitive impairment. But one day, when an insurance assessor came to her home, Jones answered in her underwear, in a state of confusion, and fell. <\/span><\/p>\n

Hospital staff determined that Jones, in her late 80s, was taking two medications for insomnia: clonazepam (Klonopin), prescribed by her physician, along with Advil PM, an over-the-counter (OTC) medication she had self-prescribed.<\/span><\/p>\n

\u201cThe combination of these medications had a significant effect on her cognition and her ability to maintain safety, causing her to fall multiple times,\u201d said Katie Pescatello, a nurse practitioner and hospitalist who helped care for Jones. \u201cAfter those medications were removed, she returned to her normal cognitive status.\u201d <\/span><\/p>\n

Jones\u2019s ordeal is far from rare. As many as one-third of emergency hospital admissions among people 75 or older may be in part due to medication-related problems. Those with cognitive impairment are especially vulnerable. <\/span><\/p>\n

To help address the problem, the <\/span>Journal of the American Geriatrics Society<\/span><\/i> (AGS) maintains the Beers Criteria, a directory of drugs that are potentially harmful for older adults. In July 2025, the AGS published new recommendations for treating common symptoms affecting older adults that list alternative medications as well as nonpharmacological treatments. <\/span><\/p>\n

But many patients and caregivers aren\u2019t aware of the Beers Criteria\u2014or that it includes common OTC medications that many older adults self-prescribe. <\/span><\/p>\n

\u201cPeople assume they\u2019re benign, but over-the-counter medications can be very harmful, depending on your age, your concurrent medications, and your kidney and liver function,\u201d said Dominick Trombetta, PharmD, associate professor at Wilkes University School of Pharmacy in Wilkes-Barre, PA.<\/span><\/p>\n

The Beers Criteria was developed in 1991 by the late Mark Beers, MD, and colleagues, originally as a guide to prevent improper use of medications in nursing home settings. The list gained popularity and was eventually expanded to include all older adults. The AGS has maintained the Beers Criteria since 2011 with periodic updates, most recently in 2023. <\/span><\/p>\n

Until recently, the Beers Criteria only flagged drugs whose potential for harm outweighed their intended benefits. A panel of experts would hammer out specific recommendations to guide physicians in handling common conditions that affect older adults and are often treated with Beers Criteria medications, including allergic rhinitis, pruritus (itching), pain, diabetes, involuntary weight loss, atrial fibrillation (Afib), anxiety, insomnia, delirium, gastroesophageal reflux (GERD) and recurrent urinary tract infections. <\/span><\/p>\n

The current publication also recommends alternative medications and nonpharmacological interventions, such as cognitive behavioral therapy for sleeplessness, or exercise, physical therapy and psychological interventions for pain.  <\/span><\/p>\n

Problematic OTC Medications<\/b><\/p>\n

Among the most common OTC medications on the list are sedating antihistamines, including Benadryl (diphenhydramine), Unisom (doxylamine) and Bonine\/Dramamine (meclizine). These medications are used to treat allergies or to aid with sleep, since they cause drowsiness in many patients. (They are sometimes called \u201cfirst-generation\u201d antihistamines, distinguishing them from second- and third-generation antihistamines, which are less likely to cause sleepiness and less likely to cause interactions with other medications.)<\/span><\/p>\n

With these medications, older adults have increased risk of side effects, which may include dry mouth, constipation, overheating (especially during the warm summer months) and short-term confusion, according to Man-Khoi Nguyen, PharmD, director of clinical pharmacy at Archwell Health in Nashville, TN.   <\/span><\/p>\n

\u201cThe risk increases even further with regular use,\u201d he said. \u201cThe drugs are also linked with increased risk of falls and dementia.\u201d <\/span><\/p>\n

Many older adults aren\u2019t aware of these potential dangers. <\/span><\/p>\n

\u201cPatients and caregivers often know about issues like the potential for aspirin to cause stomach bleeding, for example,\u201d said Pescatello. \u201cBut not many people are aware that antihistamines, or any medicine with \u2018PM\u2019 in the name, pose extra risks for older adults.\u201d <\/span><\/p>\n

Another common class of OTC medications included in the Beers Criteria: nonsteroidal anti-inflammatory drugs\u2014or NSAIDs\u2014such as Motrin and Advil (ibuprofen) and Aleve (naproxen.) These may increase blood pressure, increase risk of ulcers or stomach bleeding or may worsen heart failure or kidney disease in patients with these conditions.<\/span><\/p>\n

\u201cWe see older patients, almost on a weekly basis, who\u2019ve taken NSAIDs and who come to the hospital because of either acute stomach bleeding or even acute kidney injury,\u201d said Trombetta.<\/span><\/p>\n

The Beers Criteria also cautions against prolonged use of proton pump inhibitors such as Prilosec (omeprazole) or Nexium (esomeprazole) for heartburn or acid reflux. When taken for longer than eight weeks, PPIs are associated with an increased risk of bone loss, fractures and a severe type of diarrhea called C. diff.   <\/span><\/p>\n

Common Problems, Alternative Interventions<\/b><\/p>\n

The July update lists medication alternatives that are generally considered safer than Beers Criteria drugs. For example, for allergic rhinitis (hay fever or seasonal allergies), instead of first-generation antihistamines, the update recommends nasal sprays (which are absorbed into the bloodstream less than oral medications and have fewer adverse effects). For those taking oral antihistamines, second- or third-generation antihistamines (such as loratadine (Claritin) or cetirizine (Zyrtec)) are preferred. <\/span><\/p>\n

The July update also details nonpharmacological interventions for several common symptoms, many of which, it says, \u201care often safer or equally or more effective than the potentially inappropriate medications they are replacing.\u201d<\/span>   <\/span><\/p>\n

Examples include: <\/span><\/p>\n