Earlier this year, the American Geriatrics Society (AGS) published an update to the AGS Beers Criteria^® for potentially inappropriate medication (PIM) use in older adults (65 years of age and older). Older adults are more likely to experience unwanted adverse effects and be more sensitive to certain medications. Since first developed in 1991 by the late Dr. Mark Beers and colleagues, this list of PIMs is typically updated every few years by a panel of experts who review new data and literature to help maintain the content and make updates as appropriate.

In the 2023 update, a few medications (e.g., warfarin, rivaroxaban) were added based on new evidence, emerging data, or clinical concern. Additionally, some medications (e.g., fenoprofen, ketoprofen) were removed due to low use (defined as less than 4,000 Medicare beneficiaries 65 years of age and older in 2020) or not currently marketed in the United States (e.g., belladonna, tolmetin). However, AGS denoted that medications removed from the 2023 criteria are still considered potentially inappropriate. Although such medications are not currently marketed, they could be marketed in the future. Therefore, these medications should still be used with caution or avoided in older adults.

Clinicians and others (e.g., educators, healthcare consumers, pharmacy benefit managers, researchers, regulators) use the AGS Beers Criteria as a guide to identify which medications are potentially harmful and should be avoided, or prescribed with caution, in older adults. Examples of harmful adverse effects may include increased risk of confusion, sedation, delirium, dementia, gastrointestinal bleeding, falls, and fractures. The AGS Beers Criteria should be applied in all settings of care (e.g., ambulatory, acute, institutions), except hospice and end-of-life care settings.

Impact on workers’ compensation and auto no-fault

When we know the age of the injured person, Optum evaluates safety concerns, provides education, and attempts to reduce exposure to PIMs in older adults. PIMs identified through our clinical programs may be brought to the attention of the treating prescriber to consider recommendations for safer therapy. The claims professional may also be notified of a medication in the AGS Beers Criteria. While Optum does not block a medication strictly for being included on the Beers list, some PIMs may block on our formularies for reasons other than the AGS Beers Criteria (e.g., not first-line therapy or supported by guidelines).

When reviewing claims for anyone approaching or older than 65 years of age, it is recommended to discuss the older adult’s medication therapy with the treating prescriber(s) to determine if: 

• The prescribed medication has the potential to cause a significant risk to the older adult
• The prescribed medication is appropriate for ongoing use, based on a risk-benefit analysis
• A safer alternative medication exists which does not introduce a drug-drug interaction
• A dose reduction may be warranted

It is important to mention that if a PIM can be replaced, abrupt discontinuation may not be recommended, depending on the medication, comorbidities, and other factors. Therefore, transitioning to a safer alternative medication may take several weeks to months.

Below are some examples of therapeutic classes and medications often prescribed for the treatment of a work-related or auto injury included in the AGS Beers Criteria (list is not all-inclusive). 

For more examples of medications on the Beers Criteria, click here.

If you have any questions about our clinical programs or the AGS Beers Criteria, please contact your account manager, clinical liaison or our Clinical Services team at 1-877-275-7674 ext. 8612. 

Source:
By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;1-30. doi:10.1111/jgs.18372