Clinical Question

What medications do the American Geriatric Society (AGS) say are problematic for older adults?

Bottom Line

The 2023 AGS Beers Criteria provides many resources to assist in the rational prescribing of medications for older adults. The AGS panel encourages the judicious use of these resources to aid in shared decision-making. (Level of Evidence = 5)

Synopsis

The AGS convened a 12-person panel to evaluate systematic reviews and other evidence to update the 2019 AGS Beers Criteria. The panel used an iterative voting process to develop their final recommendations. One decision was to eliminate medications from the previous list that are rarely prescribed in the United States or are no longer on the market (such as flurazepam or reserpine). The list is fairly exhaustive, but the panel calls out a few noteworthy changes. For example, in their recommendations for using anticoagulants, the authors recommend not using warfarin as initial therapy for adults with nonvalvular atrial fibrillation or for treating venous thromboembolic phenomena. The panel recommends avoiding aspirin for the primary prevention of cardiovascular disease, anticholinergic drugs, oral and transdermal estrogen, and sulfonylureas. The panel expanded the sections on drug-disease and drug-drug interactions. Recommendations for deprescribing medications on the list are also included. The panel attempted to address many limitations to their list. One significant limitation is the inability to distinguish between the potential harms in the frail patient and the potential harms, as well as benefits, in the healthy older adult. Physicians should use the list as a guide to therapeutic decisions, but not as an absolute mandate.