Using the Beers Medication List: Facility Overview and FAQ
Nearly 90% of adults over the age of 65 are prescribed at least one medication and half of those individuals take more than five medications per month. Even when they’re prescribed in appropriate and safe dosages, drug combinations place elderly patients at an increased risk of adverse reaction, injury, and death.
Healthcare providers reference the Beers medication list when providing care to elderly patients to ensure that prescribed medications are safe and appropriate. In this article, we review components of the Beers Criteria list, explain how providers can utilize it effectively, and describe how to find an updated list of high-risk medications to help prevent harm to patients.
What Is the Beers Medication List?
The Beers list, named after geriatrician Mark H. Beers, MD, was first created in 1991 by the American Geriatrics Society (AGS) to improve healthcare quality and safety for older adults.
The Beers medication safety list outlines the risks associated with particular drug dosages and combinations, and warns providers of the possible reactions that could occur if medications are incorrectly mixed. Before a healthcare provider prescribes a patient multiple drugs, they must first reference the Beers safety list to ensure that the medication and dosage are safe for the patient.
What Are the 5 Beers Criteria?
The Beers medication list organizes drug safety criteria into five general categories, which are outlined in the table below.
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| Category 1 | Medications considered potentially inappropriate |
| Category 2 | Medications potentially inappropriate in patients with certain diseases or syndromes |
| Category 3 | Medications to be used with caution |
| Category 4 | Potentially inappropriate drug-drug interactions |
| Category 5 | Medications whose dosages should be adjusted based on renal function |
These categories provide structure for the five different AGS medication safety lists. These lists contain drug warnings and are used to prevent adverse reactions in elderly patients.
Which Drugs Are Included in the Beers Criteria Medication List?
The Beers medication safety list outlines 40 different medications to “completely avoid” when prescribing to individuals over the age of 65. Nearly 50 additional drugs are marked as “potentially harmful” for patients with certain diseases or conditions. These medications include, but are not limited to:
- Antihistamines (hydroxyzine, promethazine, doxylamine, etc.)
- Antidepressants (paroxetine, amitriptyline, amoxapine, etc.)
- Pain medications (ibuprofen, ketorolac, naproxen, etc.)
- Medications for high blood pressure (clonidine, doxazosin, nifedipine, etc.)
- Antiarrhythmics (amiodarone, rivaroxaban, digoxin, etc.)
Rationales and recommendations are provided for each listed drug to help physicians make informed decisions when considering the pros and cons of each medication. By tabulating medication safety criteria, the Beers Criteria list helps healthcare providers optimize drug therapy and reduce medication errors.
How Often Is the AGS Beers List Updated?
The American Geriatrics Society analyzes scientific evidence and updates the Beers medication list every three years. A panel of experts reviews the most recent clinical trials and research studies, adding or removing medications based on published evidence.
How Can Facilities Utilize the Beers Criteria List to Improve Patient Safety?
Potentially harmful drug combinations, known as polypharmacy, place elderly patients at an increased risk for liver and kidney injury, oversedation, and falls. When developing treatment strategies for patients over the age of 65, it’s important that doctors and pharmacists reference the Beers drug safety criteria to keep patients safe and healthy.
Some of the listed hazardous drug combinations involve over-the-counter medications like ibuprofen and diphenhydramine (Benadryl). Patients may be unaware of the risks involved when taking certain medications and could suffer disastrous consequences if not counseled appropriately.
Educating patients and their family members about the dangers of polypharmacy can help prevent adverse medication reactions. Healthcare providers should review Beers safety criteria with the patient and provide them with a copy of the list for future use.
Where Can Facilities Find an Updated Beers List?
Knowing how to utilize the Beers tool is the first step in ensuring high-quality care. However, it might be difficult for healthcare providers to know where to find this information. Facility staff, along with patients and their families, can access an accurate and up-to-date list using any of the methods listed below.
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| Journal of the American Geriatrics Society | Providers can reference the entire Beers publication, with full text and tables included. |
| AGS mobile app | Here, healthcare staff can perform quick searches by drug name and class, and can bookmark and share resources directly to patients and family members. |
| Pocket reference card | This resource condenses the full document into a smaller and more accessible guide. It’s the perfect size to slide into a scrub pocket or notebook for quick reference. |
Ensure Your Safety Protocols Are Current and Effective
Educating your staff on how to locate and use the current Beers medication list and keeping your care guidelines up-to-date can prevent patient harm and minimize the legal and financial risks for your facility. Stay in the loop on this and other healthcare management topics, regulatory resources, and tips for improving patient safety and care quality at your facility.