Study suggests strong sense of purpose in life promotes cognitive resilience among middle-aged adults

by Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research

Associations between brain burden and cognition. Scatter plot showing the association between WMLs and executive performance as a function of the PiL group. Data is presented with Z scores. Abbreviations: EFc, executive functioning composite; HP, higher purpose in life; LP, lower power in life; WMLs, white matter lesions. Credit: Alzheimer's Research & Therapy (2023). DOI: 10.1186/s13195-023-01198-6

New research suggests that having a stronger purpose in life (PiL) may promote cognitive resilience among middle-aged adults. Cognitive resilience refers to the capacity of the brain to cope with stressors, injuries and pathology, and resist the development of symptoms or disabilities. Furthermore, having a purposeful life implies changes in the organization of the brain with one specific brain network, the dorsal Default Mode Network, showing greater functional connections within its components and with other brain areas. This may represent a neuroprotection mechanism that ultimately ensures better cognitive function into old age.

10 may 2023--These are among the findings in the article, "Purpose In Life Promotes Resilience To Age-Related Brain Burden And Neuroprotection Through Functional Connectivity In Middle-Aged Adults," published in the journal Alzheimer's Research & Therapy.

"The present data extend previous findings found in advanced age and pathological aging, such as Alzheimer's Disease, revealing that having a strong sense of purpose might confer resilience already in middle age," said author Dr. Kilian Abellaneda-Pérez, Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain.

"The fact that individuals in the higher purpose in life group had greater connectivity between specific Dorsal default-mode network nodes, which correlated with cognitive performance, suggest such changes in the functional organization of the brain may represent the mechanism by which a greater purpose in life promotes brain health and protects the brain from dysfunction even in the face of stress, adversity and illness," said Dr. Alvaro Pascual-Leone, Medical Director, Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife; and Department of Neurology, Harvard Medical School.

He concludes, "What is also exciting is that each of us, with appropriate guidance and support, can develop and sustain a robust sense of purpose and thus contribute to our brain health and well-being."

Disease-modifying agents to counteract cognitive impairment in older age remain elusive. Hence, identifying modifiable factors promoting brain reserve and resilience is paramount. In Alzheimer's disease, education and occupation are typical reserve proxies. However, the importance of psychological factors is being increasingly recognized, as their operating biological mechanisms are elucidated.

Purpose in life, one of the pillars of psychological well-being, has previously been found to reduce the deleterious effects of Alzheimer's Disease-related pathological changes on cognition. However, whether purpose in life operates as a cognitive resilience factor in middle-aged individuals, and what are the underlying neural mechanisms remains unknown.

Data was obtained from 624 middle-aged adults (mean age 53.71±6.9; 303 women) from the Barcelona Brain Health Initiative cohort. Individuals with lower (N=146) and higher (N=100) purpose in life (PiL) rates, according to the division of this variable into quintiles, were compared in terms of cognitive status, a measure reflecting brain burden (white matter lesions; WMLs), and resting-state functional connectivity (rs-FC), examining system segregation (SyS) parameters using 14 common brain circuits.

Neuropsychological status and WMLs burden did not differ between PiL groups. However, in the lower PiL group greater WMLs entailed a negative impact on executive functions. Subjects in the higher PiL group showed lower SyS of the dorsal DMN (dDMN), indicating lesser segregation of this network from other brain circuits.

Specifically, higher PiL individuals had greater inter-network connectivity between specific dDMN nodes, including the frontal cortex, the hippocampal formation, the midcingulate region, and the rest of the brain. Greater functional connectivity in some of these nodes positively correlated with cognitive performance.

More information: Kilian Abellaneda-Pérez et al, Purpose in life promotes resilience to age-related brain burden in middle-aged adults, Alzheimer's Research & Therapy (2023). DOI: 10.1186/s13195-023-01198-6

Journal information: Alzheimer\'s Research & Therapy 

 

A myth no more: Cranberry products can prevent urinary tract infections for women

by Flinders University

Credit: CC0 Public Domain

Drinking cranberry juice has long been a mythical prevention strategy for women who develop a urinary tract infection—and new medical evidence shows consuming cranberry products is an effective way to prevent a UTI before it gets started.

10 may 2023--A global study looking at the benefits of cranberry products published in Cochrane Reviews has determined cranberry juice, and its supplements, reduce the risk of repeat symptomatic UTIs in women by more than a quarter, in children by more than half, and in people susceptible to UTI following medical interventions by about 53%.

Cranberry juice and healthcare supplements that commonly include the fruit, such as capsules and tablets, have long been promoted as a readily available solution to ward off the infection but the most recent review in 2012, with evidence from 24 trials, showed no benefit from the products.

The medical scientists behind this updated review from Flinders University and The Children's Hospital at Westmead aimed to update these findings, as an important step in determining the effectiveness of cranberry products by looking at 50 more recent trials that included almost 9000 participants.

"This incredible result didn't really surprise us, as we're taught that when there's more and better evidence, the truth will ultimately come out. UTIs are horrible and very common; about a third of women will experience one, as will many elderly people and also people with bladder issues from spinal cord injury or other conditions," says the study lead author Dr. Gabrielle Williams.

"Even back in 1973, my mum was told to try cranberry juice to prevent her horrible and frequent UTIs, and for her it's been a saviour. Despite me niggling in her ear about evidence, she's continued to take it daily, first as the nasty sour juice and in recent years, the easy to swallow capsules. As soon as she stops, wham the symptoms are back. As usual, it turns out that mum was right! Cranberry products can help some women prevent UTIs."

Flinders University epidemiologist Dr. Jacqueline Stephens, a co-author of the study, says if the UTI persists untreated it can move to the kidneys and cause pain and more complications, including sepsis in very severe cases, so prevention is the most effective way to reduce risks.

"Most UTIs are effectively, and pretty quickly, treated with antibiotics, sometimes as little as one dose can cure the problem. Unfortunately, in some people UTIs keep coming back. Without being sure if or how it works, some healthcare providers began suggesting it to their patients. It was a harmless, easy option at the time. Even centuries ago, Native Americans reportedly ate cranberries for bladder problems, leading somewhat more recently, to laboratory scientists exploring what it was in cranberries that helped and how it might work."

"The studies we looked at included a range of methods to determine the benefits of cranberry products. The vast majority compared cranberry products with a placebo or no treatment for UTI and determined drinking cranberries as a juice or taking capsules reduced the number of UTIs in women with recurrent cases, in children and in people susceptible to UTi's following medical interventions such as bladder radiotherapy."

"It's also important to consider that few people reported any side effects with the most common being tummy pain based on the results. We also did not find enough information to determine if cranberry products are more or less effective compared with antibiotics or probiotics in preventing further UTIs."

The data also doesn't show any benefit for elderly people, pregnant women or in people with bladder emptying problems.

Senior Author, Professor Jonathan Craig, Vice President and Executive Dean of the College of Medicine & Public Health at Flinders University, says the real benefits of cranberry products became clear when the researchers expanded the scope of the review to include the most recently available clinical data.

"This is a review of the totality of the evidence and as new evidence emerges, new findings might occur. In this case, the new evidence shows a very positive finding that cranberry juice can prevent UTI in susceptible people," says Professor Craig.

"We have shown the efficacy of cranberry products for the treatment of UTIs using all the evidence published on this topic since the mid-nineties. The earlier versions of this review didn't have enough evidence to determine efficacy and subsequent clinical trials showed varied results, but in this updated review the volume of data has shown this new finding."

The study authors conclude that while cranberry products do help prevent UTIs in women with frequent recurrence, more studies are needed to further clarify who with UTI would benefit most from cranberry products.

More information: Cranberries for preventing urinary tract infections, Cochrane Database of Systematic Reviews (2023). DOI: 10.1002/14651858.CD001321.pub6

Journal information: Cochrane Library 

 

Social interaction reduces dementia risk and increases longevity

by University of New South Wales

Credit: CC0 Public Domain

Spending time with loved ones can have significant health benefits as we age, according to a new meta-analysis study from the Centre for Healthy Brain Ageing (CHeBA) at UNSW Sydney.

10 may 2023--The researchers studied the link between social connections in older people and the risk of mild cognitive impairment (MCI), dementia and mortality. They pooled together the results of 13 international studies, which followed people aged 65 years and above over long periods of time.

The research is published today in Alzheimer's & Dementia.

"We know from previous research that social connections are important for our health and being isolated puts us at higher risk of dementia and death," said first author Dr. Suraj Samtani, who is a clinical psychologist and researcher at CHeBA.

"Our goal was to find which social connections protect us from dementia and death."

Studying aging populations

The researchers obtained results from studies in low, middle and high-income countries across the world. These included Australia, North America, and several nations in Europe, South America, Asia, and Africa. The study population is more diverse than previous meta-analyses, which have mainly focused on North America and Europe.

Then the researchers analyzed information about the social connections of the study participants. They were interested in the social connection type (e.g., being in a relationship or married, engaging with a community group), function (e.g., social support, having a confidante), and quality (e.g., level of relationship satisfaction).

Finally, the researchers looked at whether the participants developed MCI or dementia, or passed away, during the studies. They controlled for other variables which could influence these outcomes including age, sex, education level, lifestyle factors and other chronic diseases.

"We looked at social variables across these studies, such as living with others, interacting with friends and family, engaging in community activities, and social support," Dr. Samtani said. "We wanted to know which of these are associated with risk of getting dementia over time or dying."

Protective effects of social connections

Among the study participants, good social connections were associated with a lower risk of MCI, dementia and death.

"We found that frequent interactions—monthly or weekly—with family and friends and having someone to talk to reduced the risk of getting dementia. We also found that living with others and doing community activities reduced the risk of dying," Dr. Samtani said.

Why would social interaction be linked to MCI, dementia and death? Many other studies show that poor social connections are associated with poorer lifestyle and poorer health.

For example, close relationships can have a stress buffering effect, as we confide in and receive support from these individuals. Controlling stress is important for brain and overall health.

Another example is that our family, friends and community members may influence us to take on healthy behaviors. This phenomenon, exemplified by your friends dragging you to park run at 7am on a Saturday, is known as 'social contagion'.

One limitation of the findings is the 'chicken or the egg' problem. Participants who had already MCI or dementia at the beginning of the studies were excluded from the analysis. However, it is possible that they had some undetected cognitive and physical health issues. These could impact their social interactions, rather than the other way around.

Tips to stay healthy

The researchers recommend that we prioritize social connection to reduce risk of cognitive decline and live longer.

"Try to meet with friends and family at least once a month, take part in community activities like volunteering or a rotary club, and open your heart to someone when you feel stressed. Living with others, for example in an intergenerational household, is also helpful," Dr. Samtani said.

"Connecting with others helps us to keep our bodies and minds healthy."

The researchers at CHeBA are now looking at interventions to improve the social connections of older adults, to protect their brain and overall health. Dr. Samtani has recently been awarded a Dementia Australia Research Foundation post-doctoral fellowship to trial a social cognition intervention for older adults with memory concerns.

"We hope that helping people to stay engaged in conversations and maintain healthy friendships and relationships will help them to stay healthy and happy," Dr. Samtani said.

More information: Gowsaly Mahalingam et al, Social connections and risk of incident mild cognitive impairment, dementia, and mortality in 13 longitudinal cohort studies of ageing, Alzheimer's & Dementia (2023). DOI: 10.1002/alz.13072

 

Study provides evidence that breathing exercises may reduce Alzheimer's risk

by Constance Sommer, USC Leonard Davis School of Gerontology

Credit: Unsplash/CC0 Public Domain

The exercise was simple: inhale for a count of five, then exhale for a count of five. Do that for 20 minutes, twice a day, for four weeks.

10 may 2023--These brief breathing sessions had significant impacts: Volunteers' heart rate variability increased during each exercise period and the levels of amyloid-beta peptides circulating in their blood decreased over the four weeks of the experiment.

That's the finding of a new study from USC Leonard Davis School of Gerontology Professor Mara Mather. Published last month in the journal Scientific Reports, the study may be the first to discover a way that adults, both young and old, can reduce their amyloid beta levels: via breathing exercises that lower the levels in our blood of these peptides associated with Alzheimer's disease.

That's because the way we breathe affects our heart rate, which in turn affects our nervous system and the way our brain produces proteins and clears them away. While we are awake and active, we typically use our sympathetic nervous system. This is sometimes known as the "fight or flight" system but we also use it to exercise, to focus attention, and even to help create long-lasting memories. While the sympathetic nervous system is activated, there isn't much variation in the time between each heartbeat. In contrast, when the parasympathetic system is activated, heart rates increase during inhaling and decrease during exhaling.

When we're young—or older, but very fit—our body slides easily between the sympathetic nervous system and its partner, the parasympathetic nervous system. Sometimes known as the "rest and digest" part of our system, the parasympathetic nervous system allows us to calm down, digest food easily, and sleep soundly. When these kinds of activities occur, the variation between heartbeats is greater.

But as we age, scientists are learning, our ability to access our parasympathetic nervous system—and thus, our heart rate variation—decreases dramatically.

A 2020 study using smart watches found that heart rate variability drops on average 80 percent between twenty and sixty years old. This finding could partially explain why we struggle to sleep deeply as we age.

"We know the sympathetic and parasympathetic systems influence the production and clearance of Alzheimer's related peptides and proteins," said Mather, who directs the Emotion & Cognition Lab at the Leonard Davis School of Gerontology. "Nevertheless, there's been very little research on how these physiological changes in aging might be contributing to the factors that make it conducive for someone to develop Alzheimer's disease or not."

Mather and fellow researchers from USC, UC Irvine and UCLA asked participants to do biofeedback exercises twice a day, for 20 minutes at a time. All the participants clipped a heart monitor onto their ear; that monitor was connected to a laptop the researchers provided.

Half the group was instructed to think of calm things, like a beach scene or a walk in a park, or to listen to calm music. Meanwhile, they were instructed to keep an eye on their heart rate as displayed on the laptop screen, making sure the heart rate line stayed as steady as possible while they meditated.

The other group was told to pace their breathing in rhythm with a pacer on the laptop screen—when the square rose, they inhaled, and when the square dropped, they exhaled. They also monitored their heart rates, which tended to rise in peaks as they inhaled and dip down to baseline as they exhaled. Their goal was to increase the breathing-induced oscillations in their heart rate.

Intervention effect on Aβ and tau levels. Orange represents Osc+ and green represents Osc−. The upper and lower box boundaries indicate the 75th and 25th percentiles respectively. The gray horizontal bar inside each box shows a median value for the box, and the colored vertical line describes the mean and standard error. The outliers are included for the summary statistics but are not shown in the figure. Credit: Scientific Reports (2023). DOI: 10.1038/s41598-023-30167-0

The researchers took blood samples before the participants began the experiment and again, after four weeks of biofeedback training. Then the researchers examined the plasma of participants from both groups, looking for amyloid beta peptides.

In particular, the researchers looked at two peptides, amyloid beta 40 and 42.

Accumulation of amyloid beta in the brain due to increased production and/or decreased clearance is believed to trigger the Alzheimer's disease process. In healthy adults who do not yet have signs of amyloid accumulation in the brain, a meta-analysis shows that higher levels of amyloid beta 40 and 42 in circulating blood predicts a greater risk of developing Alzheimer's.

In Mather and colleagues' study, plasma levels of both peptides decreased in the group who breathed slowly and tried to increase their heart rate variability (HRV) by increasing oscillations.

Now researchers want to figure out why the peptides decrease when HRV increases, said Jungwon Min, a graduate student in psychology and the lead author on the study. Is it because fewer peptides are being produced? Or because the body clears them out better? Or some combination of both?

Though the current study does give some hints.

"Based on the data we have, it appears the decrease in amyloid beta is due more to decreased production," she said. "But that doesn't exclude the possibility of increased clearance."

Of the study's 108 participants, half were young (ages 18 to 30) and half were old (ages 55 to 80). The younger and the older adults showed similar effects of the interventions on plasma amyloid beta levels.

The study appears to be the first to find that behavioral interventions can reduce the level of amyloid beta peptides in plasma. Previous research has demonstrated that sleep deprivation and stress can increase amyloid beta levels, but it has proved more challenging to decrease amyloid beta with behavioral interventions.

"At least to date, exercise interventions have not decreased Aβ [amyloid beta] levels," said Mather. "Regularly practicing slow-paced breathing via HRV biofeedback may be a low-cost and low-risk way to reduce plasma Aβ levels and to keep them low throughout adulthood."

Other study co-authors were Kaoru Nashiro, Hyun Joo Yoo, Shai Porat, Christine Cho and Junxiang Wan, of USC; Jeremy Rouanet, Allesandra Cadete Martini, Elizabeth Head, Daniel A. Nation and Julian F. Thayer, of UC Irvine; and Steve W. Cole of UCLA.

More information: Jungwon Min et al, Modulating heart rate oscillation affects plasma amyloid beta and tau levels in younger and older adults, Scientific Reports (2023). DOI: 10.1038/s41598-023-30167-0

Journal information: Scientific Reports 

 

GlyNAC supplementation found to improve cognitive decline and brain health in aging

by Homa Shalchi, Baylor College of Medicine

Study experimental details. GCLC and GCLM = catalytic and modifier subunits of glutamate cysteine ligase enzyme; GSS = glutathione synthetase enzyme; GLUT1 and GLUT3 = glucose transporters 1 and 3; PGC1α = peroxisome proliferator-activated receptor-gamma coactivator 1-alpha; ATP5A = mitochondrial adenosine triphosphate synthase F1 subunit alpha; LC3A/B = Light chain 3 microtubule-associated proteins 1A and 1B; PINK1 = PTEN-induced kinase; TSPO = translocator protein; PH2AX = phosphor H2A histone family member X; BDNF = brain-derived neurotrophic factor; GDNF = glial-derived neurotrophic factor; NGF = nerve growth factor. Credit: Antioxidants (2023). DOI: 10.3390/antiox12051042

As people get older, they aspire to live healthy lives as free as possible from the natural decline of cognitive abilities that occurs with aging. At Baylor College of Medicine, researchers have been studying the biological underpinnings of age-associated cognitive decline and developing nutritional strategies to promote healthy brain aging.

10 may 2023--They report today in the journal Antioxidants that supplementing GlyNAC—a combination of glycine and N-acetylcysteine as precursors of the natural antioxidant glutathione—improved or reversed age-associated cognitive decline in old mice and improved multiple associated defects in the aging brain.

The findings are consistent with improvements observed after supplementing older adults with GlyNAC, as reported in their 2021 pilot human trial; therefore, the findings reported here are likely applicable to humans.

"For over two decades, my lab has been studying natural aging in older humans and aged mice," said corresponding and senior author Dr. Rajagopal Sekhar, professor of medicine—endocrinology, diabetes and metabolism at Baylor.

"Our work provides an understanding of how age-associated cognitive decline in older humans is linked to glutathione deficiency, increased oxidative stress, mitochondrial dysfunction, abnormal glucose metabolism and insulin resistance, inflammation and low levels of neurotrophic or neuron-supporting factors, and that supplementing GlyNAC reverses these defects and improves cognition."

Human studies only permit measurements at the whole-body level, so in this study the researchers studied mice to investigate defects directly in the aging brain.

This study is important for many reasons: it assesses the reversibility of naturally occurring cognitive decline in aging instead of cognitive decline resulting from introducing gene defects; increased age is identified as the most important risk factor for Alzheimer's disease; and these naturally occurring defects were studied directly in the brain.

Sekhar and his team worked with three groups of mice. Two groups were aged naturally side-by-side until they were 90 weeks old, which is similar to a 70-year-old person. At 90 weeks of age, both groups of old mice were evaluated for their cognitive abilities, such as remembering the correct route in a maze that leads to a food reward.

These results were compared to those of young mice, the third group. Then, one group of old mice began a GlyNAC-supplemented diet, while the other group, called the old-controls, continued their regular diet without GlyNAC supplementation.

After completing eight weeks on their respective diets, the animals' cognitive abilities were evaluated again and their brains analyzed to measure specific brain defects that had previously been associated with cognitive impairment in studies by others. The results of these analyses in old mice supplemented with GlyNAC were compared with those of the old-control group and with the corresponding data obtained from young mice.

"We were very excited with the findings of this study," Sekhar said. "Compared to young mice, old mice had cognitive impairment and many brain abnormalities such as glutathione deficiency, increased oxidative stress, impaired mitochondrial function, elevated inflammation, genomic damage and lower levels of brain-supporting factors. Importantly, we found evidence that there was a shortage of transporters responsible for moving glucose, the main fuel for the brain, into this organ."

"This problem gets worse because the mitochondria, the engines that burn glucose to provide energy, were also not working well in the brain. The brain requires a very large amount of energy for its function, and these defects suggest that the aging brain is starved of energy, which could result in cognition decline."

GlyNAC supplementation in old mice corrected brain glutathione deficiency, improved brain glucose transporters, reversed mitochondrial dysfunction and improved cognition. In addition, GlyNAC supplementation reduced oxidative stress, inflammation and genomic damage and improved neurotrophic factors.

"It is really exciting to see so many improvements in the brain with GlyNAC supplementation, as it provides evidence that it may now be possible to improve brain health in aging," Sekhar said. "Going forward, we plan to conduct a larger randomized clinical trial in older people to study the effect of GlyNAC supplementation on improving cognitive and brain health in aging."

Previous rodent studies from the Sekhar lab reported that GlyNAC supplementation improved similar biological defects in the heart, liver and kidneys, and also increased length of life. A recently published randomized clinical trial in older humans provided evidence of similar improvements in skeletal muscle and blood and reversal of aging hallmarks.

The results of this study are consistent with these prior studies and make an advancement by supporting the beneficial role of GlyNAC supplementation to specifically promote brain health and support cognitive function in aging.

"In addition, our findings may also have implications for Alzheimer's disease and mild cognitive impairment, because similar defects are also reported in these conditions," Sekhar said. "We are currently evaluating whether older people with mild cognitive impairment have glutathione deficiency, compared to older people without a diagnosis of cognitive impairment."

More information: Premranjan Kumar et al, GlyNAC (Glycine and N-Acetylcysteine) Supplementation in Old Mice Improves Brain Glutathione Deficiency, Oxidative Stress, Glucose Uptake, Mitochondrial Dysfunction, Genomic Damage, Inflammation and Neurotrophic Factors to Reverse Age-Associated Cognitive Decline: Implications for Improving Brain Health in Aging, Antioxidants (2023). DOI: 10.3390/antiox12051042. www.mdpi.com/2076-3921/12/5/1042

Journal information: Antioxidants 

 

Many older adults take multiple medications; updated criteria will help ensure they are appropriate

by American Geriatrics Society

Credit: CC0 Public Domain

Today, the American Geriatrics Society (AGS) released the 2023 update to the AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. The AGS Beers Criteria serves as a comprehensive list of medications that older people should potentially avoid or consider using with caution because they often present unnecessary risks for this population. Given that—according to the National Center for Health Statistics, United States (NCHSUS)—more than 88% of older people use at least one prescription and more than 66% use three or more in any given month, the AGS Beers Criteria are an important clinical, educational and quality assurance tool for clinicians across disciplines and the healthcare system as a whole.

10 may 2023--"Medications have a vital role to play in helping us to remain healthy, active, and engaged in our communities," said Donna M. Fick, Ph.D., GCNS-BC, FGSA, FAAN, AGSF, AGS President-elect and a member of the AGS Beers Criteria Expert Panel. "The 2023 AGS Beers Criteria is based on the best available evidence and supports person-centered decision-making that takes into account what matters to an older person, considers both drug and non-drug approaches to care, and is focused on maximizing health while minimizing unnecessary risk."

Though not an exhaustive catalogue of inappropriate treatments, the five lists included in the AGS Beers Criteria describe particular medications where the best available evidence suggests they should be:

1. Avoided by most older adults (outside of hospice and palliative care settings);
2. Avoided by older adults with specific health conditions;
3. Used with caution because of the potential for harmful side effects; or
4. Avoided in combination with other treatments because of the risk for harmful "drug-drug" interactions; or
5. Dosed differently or avoided among older adults with reduced kidney function, which impacts how the body processes medicine.

First developed by the late Mark Beers, MD, and colleagues in 1991, the AGS took over maintenance and updating of the AGS Beers Criteria in 2011. For the 2023 update, an expert panel reviewed more than 1,500 clinical trials and research studies published between 2017 and 2022. The resulting 2023 AGS Beers Criteria include:

• Over three dozen individual medications or medication classes to avoid for most older people.
• 40+ medications or medication classes to use with caution or avoid when someone lives with certain diseases or conditions.

The expert panel also moved several medications to different categories or revised guidance based on new evidence. To simplify and increase usability of the five lists comprising the criteria, the panel moved a number of medications to a separate list given that they have low usage or are no longer available in the United States. The panel still considers these medications as being potentially inappropriate for use in older adults in alignment with the 2019 criteria.

"The AGS Beers Criteria offers guidance about potentially harmful treatments for all of us as we age, supporting clinicians, patients, and caregivers to choose the safest, most effective treatment when making decisions that are individualized to what matters to the person. Our goal is to improve drug therapy and outcomes by identifying and reducing the prescribing of potentially inappropriate medications in older adults," noted Todd Semla, MS, PharmD, BCGP, FCCP, AGSF, a co-chair of the 2023 AGS Beers Criteria expert panel.

"The AGS Beers Criteria should never solely dictate how medications are prescribed or be used to justify restricting health coverage," he added. "We encourage older adults who see one of their drugs listed on the AGS Beers Criteria to speak with their clinician about an alternative."

Published in its entirety in the Journal of the American Geriatrics Society, the AGS Beers Criteria is also available as a mobile app and as a pocket reference card. Both are designed to meet the needs of busy clinicians practicing in a variety of settings and are available from GeriatricsCareOnline.org. The AGS is committed to bringing the expertise of geriatrics health professionals to the public and lay versions of the Beers Criteria as well as tools to aid older adults and caregivers in understanding what medications are potentially inappropriate are available for free from HealthinAging.org.

More information: American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults, Journal of the American Geriatrics Society (2023). DOI: 10.1111/jgs.18372

Journal information: Journal of the American Geriatrics Society