There are currently 47.8 million people ages 65 and older in the United States.1 Today, they make up about 15% of the total population; by 2060, they are expected to constitute nearly 25%.1 The health of older adults is far from ideal-almost 22% of noninstitutionalized adults over age 65 are in fair or poor health.2 According to the National Center for Health Statistics, more than 90% of older adults take at least one prescription drug per day and more than 42% take five or more daily.2

Nurses play a key role in confirming that patients are prescribed the appropriate medications. They do so not just by checking to make sure a drug's indication matches the patient's diagnosis, but also by considering the patient's age, height and weight, comorbidities, and other medications (prescription and over the counter) prior to administering the drug. Nurses also assess the appropriateness of a medication when providing patient education on drug therapy, while monitoring the patient's response to therapy, when completing a medication reconciliation, and when prescribing a drug (in the case of NPs). Concerns about a patient's prescribed medications are discussed with other members of the health care team on rounds, in patient care conferences, during discharge planning, after home visits, or as part of outpatient care. The American Geriatrics Society's Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, last updated in 2015, is one tool health care providers can use to determine the appropriateness of prescribed medications for their elderly patients.

The first Beers criteria were published in 1991 by the geriatrician Mark H. Beers. In 2011, the American Geriatrics Society assumed responsibility for updating and publishing the list. But the goal of the Beers criteria remains unchanged: to promote the health of older adults by reducing exposure to potentially inappropriate medications that contribute to poor outcomes such as falls, confusion, and mortality. The Beers criteria are now appropriate to use as a resource in all practice settings and for all older adults, except those in palliative and hospice care. Although the Beers criteria are widely used in geriatric care, education, and research, many nurses may not be familiar with them.

The Beers criteria are based on evidence-based recommendations. A 13-member interdisciplinary expert panel, including nurses, pharmacists, and physicians from various practice settings with expertise in geriatrics, reviewed the literature (systematic reviews, meta-analyses, randomized controlled trials, and observational studies) relevant to older adults, published since the Beers criteria were last updated. The panel then rated the quality of the evidence as high, moderate, or low, and, based on this evidence and the documented adverse effects of medications, determined whether a drug or drug class should be considered inappropriate for older adults. The recommendations are rated on their strength as strong (harm, adverse effects, and risks clearly outweigh benefits), weak (harm, adverse effects, and risks may outweigh benefits), or insufficient (inadequate evidence to determine net harm, adverse effects, and risks).

As in previous editions, the 2015 Beers criteria include a table of inappropriate drugs, a table of drugs considered inappropriate because of drug-disease or drug-syndrome interactions that may exacerbate the disease or syndrome, and a table of drugs to be used with caution. The 2015 edition also has two new lists: drugs requiring dose adjustment in patients with impaired kidney function and non-antiinfective drug-drug interactions. Neither of these is comprehensive. However, the drugs included on these lists were believed by the expert panel to cause serious harm to older adults if doses were not adjusted or interactions not considered. Another new aspect of the 2015 Beers criteria is that, where appropriate, suggestions are made for substituting safer nonpharmacological and pharmacological therapies.

While drugs listed in the Beers criteria are generally considered inappropriate for older patients, they are not inappropriate for all older patients. Some patients may require their use. Thus, the Beers criteria should be considered as a starting point when nurses and other health care providers perform medication reviews to identify appropriateness and promote patient safety. Nurses should examine all the information in the Beers criteria, not just the lists of drugs. Understanding the rationale for the recommendations is key to using them most effectively. The full criteria, as well as a guideline titled "How to Use the American Geriatrics Society 2015 Beers Criteria-A Guide for Patients, Clinicians, Health Systems, and Payors," are available free of charge on the American Geriatrics Society website at http://www.americangeriatrics.org. Although the information is free, you need to register on the site to access it.

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