The Dangers of Ignoring the Beers Criteria—The Prescribing Cascade

Kim H. DeRhodes

doi:10.1001/jamainternmed.2019.1288

Perspective

Less Is More

May 13, 2019

The Dangers of Ignoring the Beers Criteria—The Prescribing Cascade

Kim H. DeRhodes, BS, RPh¹

Author Affiliations Article Information

¹Integrative Medicine, Novant Health, Charlotte, North Carolina

JAMA Intern Med. 2019;179(7):863-864. doi:10.1001/jamainternmed.2019.1288

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You may be at work on a Friday afternoon thinking about which brew pub you are going to visit after work or over the weekend, a pub where the list of beers may be pages long. You might spend several minutes perusing the characteristics and provenance of each beer and thinking about which beer(s) you are going to try. Are you thinking more about these kinds of beers than about Beers List medications? The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, commonly referred to as the Beers List, is a list of medications that should be avoided or used with caution in adults 65 years or older. It was originally published in 1991 and has been updated every 3 years since 2011, most recently in January 2019.¹ While other lists of medications that may be problematic in elderly patients have been published, the Beers Criteria is the best known and most commonly used.

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9 Comments for this article

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May 15, 2019

Ask: Doc, are you treating me or my condition?

Umbrine Fatima, MD, FACP | Kenmore Mercy Hospital, Buffalo, NY

Thanks for sharing your experience. I am glad your mom survived the errors. There are so many who unfortunately don't. Your mom is also fortunate to have you as the pharmacist, watching over her carefully as docs pour their "treatments" into her.

Given my extensive experience in clinical informatics and EHR development, I can confirm that the EHR vendors can certainly activate the feature to alert users when Beers list medication is prescribed. This is was one of the key feature of Clinical Decision Support (CDS) certification criteria several years ago. You may want to ask your mom's doctor to reach out to his/her EHR vendor and ask for this feature to be activated / implemented. CDS can be set to trigger alert for predefined demographic groups (for example, all age 65 or older) who are on the medications on the Beers list. The key will be for the vendors to realize the patient safety value in activating this feature.

Meanwhile I am glad that deprescribing is going vogue – there was a recent article from NYACP Geriatric Spotlight: Deprescription, The New Fashion in Prescribing! https://www.nyacp.org/i4a/headlines/headlinedetails.cfm?id=136 . Certainly it has some challenges but what worthy cause doesn’t?

Deprescribing is certainly time consuming and perhaps one of the many reasons why it is easier and faster to right a prescription than to educate, or to deprescribe. And the inherent risk of withdrawal side effects further deter the best of us. Barriers that I have come across include both physician resistance and caregiver/patient resistance to change. Change from what they have been taking for years, for example, is not an easy one to make. A 78-y/o male with severe arthralgia/myalgia on statin for primary prevention does not want to stop his statin because "it is good for the heart". That's the outcome of years of direct to consumer propaganda whereas the messages about its diminished role in primary prevention has not been presented with as much fanfare as the launch of statins was many years ago.

Regardless, we need to increase the awareness of the ADR and need to constantly assess the ongoing need to continue medications. I tell my patients to ask their doctors: "Are you treating me or my condition"? Very often many of us get so focused on GDMT that we forget who we are treating and for what outcome.

Lot more needs to be done to raise the awareness of ADRs and deprescribing. Thank you for your article.