Potentially Inappropriate Medications in the Elderly

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Beers criteria for potentially inappropriate medication use in older adults

The use of a medication is generally considered appropriate if the expected benefits of the medication outweigh the potential risks. Because older adults are more sensitive to certain adverse effects of medications, various lists of medications have been created to guide clinicians to avoid certain medications where risks generally outweigh benefits in older adults. The best known of these lists is the Beers criteria. The Beers criteria, originally developed by geriatrician Mark Beers, have been updated and revised several times since their original introduction in 1991. In November 2015, the American Geriatrics Society published the latest update to the Beers criteria, available on the AGS Web site.

Zhan criteria for potentially inappropriate medication use in the elderly

The best known criteria for potentially inappropriate medication use in the elderly are the Beers criteria. Zhan modified the Beers criteria for a study of potentially inappropriate medication use in community-dwelling elderly and reported the results.

Link to the abstract, which also includes a long list of articles that have referenced this study.

Zhan C, Sangl J, Bierman AS; et al. Potentially inappropriate medication use in the community-dwelling elderly: findings from the 1996 Medical Expenditure Panel Survey. JAMA. 2001;286(22):2823-2829.

STOPP and START Criteria

The STOPP (Screening Tool of Older People’s potentially inappropriate Prescriptions) and START (Screening Tool to Alert doctors to the Right Treatment) criteria have been attracting interest among geriatric clinicians because they are more recent than the Beers criteria and they address undertreatment among older adults along with use of medications that are potentially inappropriate.

Link to abstract (PDF) that describes the STOPP criteria.

Hamilton HJ, Gallagher PF, O’Mahony D. Inappropriate prescribing and adverse drug events in older people. BMC Geriatrics 2009; 9:5.

Link to Word document with the STOPP criteria.

Barry PJ et al. START (Screening Tool to Alert doctors to the Right Treatment)—an evidence-based screening tool to detect prescribing omissions in elderly patients. Age Ageing. 2007;36:632-638.
Link to abstract.

ASCP-AMDA Joint Position Statement on Beers criteria

ASCP and the American Medical Directors Association developed a Joint Position Statement (PDF) on the Beers List of Potentially Inappropriate Medications in Older Adults.

ASCP Resources

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