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Results of a US Consensus Panel of Experts

Donna M. Fick, PhD, RN; James W. Cooper, PhD, RPh; William E. Wade, PharmD, FASHP, FCCP; Jennifer L. Waller, PhD; J. Ross Maclean, MD; Mark H. Beers, MD

Arch Intern Med. 2003;163:2716-2724.

Background  Medication toxic effects and drug-related problems can have profound medical and safety consequences for older adults and economically affect the health care system. The purpose of this initiative was to revise and update the Beers criteria for potentially inappropriate medication use in adults 65 years and older in the United States.

Methods  This study used a modified Delphi method, a set of procedures and methods for formulating a group judgment for a subject matter in which precise information is lacking. The criteria reviewed covered 2 types of statements: (1) medications or medication classes that should generally be avoided in persons 65 years or older because they are either ineffective or they pose unnecessarily high risk for older persons and a safer alternative is available and (2) medications that should not be used in older persons known to have specific medical conditions.

Results  This study identified 48 individual medications or classes of medications to avoid in older adults and their potential concerns and 20 diseases/conditions and medications to be avoided in older adults with these conditions. Of these potentially inappropriate drugs, 66 were considered by the panel to have adverse outcomes of high severity.

Conclusions  This study is an important update of previously established criteria that have been widely used and cited. The application of the Beers criteria and other tools for identifying potentially inappropriate medication use will continue to enable providers to plan interventions for decreasing both drug-related costs and overall costs and thus minimize drug-related problems.

From the Department of Medicine, Center for Health Care Improvement (Drs Fick and Maclean); and Office of Biostatistics (Dr Waller), Medical College of Georgia, Augusta; Department of Veterans Affairs Medical Center, Augusta (Dr Fick); Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens, (Drs Cooper and Wade); and Merck & Co Inc, West Point, Pa (Dr Beers). The authors have no relevant financial interest in this article.

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