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 

New study helps determine which older adults might need help taking medications

As age increases, older adults can develop problems taking their medications. But until now, few studies have examined the traits that might cause elders to need help with their medications, or how widespread a problem this might be.

26 jun 2016--In a study published in the Journal of the American Geriatrics Society, researchers investigated this issue using data from the 10-year Duke EPESE study. They examined data from 4,106 African American and white older adults living in five counties in North Carolina.
The researchers asked the participants the question, "Are you able to take your medicine without help (in the right doses at the right time)?" The participants' health conditions included: poor vision, poor hearing, or having been diagnosed with stroke, diabetes, hypertension (also known as high blood pressure), heart attack, or cancer (except skin cancer).
The researchers also tested the participants' mental abilities and reviewed their medication containers to learn how many prescription and over-the-counter medications they took.
At the beginning of the study, 7.1 percent of participants needed help taking their medications. Three years later, 11 percent needed help who did not need help at the beginning of the study. Predictors of a new need for medication help were similar to those seen at the beginning of the study:

• Being 75-years-old or older
• Being male
• Having memory problems
• Having problems performing activities of daily living

The researchers reported that people aged 80 and older were 1.5 to 3 times as likely to need help with their medications than were people aged 65 to 69.
Men were 1.5 to 2 times as likely as women to need help. The odds of needing help were 3 to 5 times greater among people with memory challenges.
"Health conditions may worsen or not improve if older adults skip or don't take their medications properly," said Brenda D. Jamerson, PharmD, Center on Biobehavioral Health Disparities Research at Duke University. "Serious side effects may also occur from taking medications at the wrong time or in the wrong dose. Some older adults can put themselves at risk for experiencing problems if they don't receive the assistance they may need," added Dr. Jamerson.
The researchers noted their study helped identify which characteristics make it more likely that an older adult will need help taking his or her medication.

More information: Brenda D. Jamerson et al, A New Method of Identifying Characteristics of Needing Help to Take Medications in an Older Representative Community-Dwelling Population: The Older Adults Medication Assist Scale,Journal of the American Geriatrics Society (2016). DOI: 10.1111/jgs.14166


Provided by American Geriatrics Society

A Silly Pat On The Head Helps Seniors Remember Daily Med

01 aug 2009--Doing something unusual, like knocking on wood or patting yourself on the head, while taking a daily dose of medicine may be an effective strategy to help seniors remember whether they've already taken their daily medications, suggests new research from Washington University in St. Louis.

We've all heard warnings that some medications may be habit-forming, but research also shows that "getting into the habit" of taking a daily medicine in a routine and precise fashion can be a befuddling challenge for some older adults, many of whom tend to err on the side of over-medication, taking a dangerous second dose when in doubt about the first.

"In extended medication-taking situations, the habitual nature of the task may make it difficult for older adults to remember whether or not they took the medication on a particular day, especially if pill boxes are not used," explains Mark McDaniel, Ph.D., lead author of the study and a professor of psychology in Arts & Sciences at Washington University.

"To remedy this potential problem, older adults could be instructed to take their medication while placing one hand on their head or in some other unusual or silly way, like crossing their arms," he suggests. "Our results indicate that older adults can use these sorts of more complex motor tasks to effectively reduce repetition errors in habitual prospective memory tasks, such as taking a daily medication."

The study, published in a recent issue of the journal Aging, Neuropsychology, and Cognition, is co-authored by Julie M. Bugg, Ph.D., postdoctoral research scholar in psychology at Washington University; Grit M. Ramuschkat of the Department of Psychology at the University of Heidelberg, Germany; Matthias Kliegel of the Department of Psychology, Technische Universität Dresden, Germany; and Giles O. Einstein, professor and chair of psychology at Furman University in South Carolina.

McDaniel and Einstein co-authored a 2004 book on "Memory Fitness: A Guide for Successful Aging" and a 2007 book on the latest research into the nuances of prospective memory, the process of remembering to perform an action at an appropriate time in the future.

In previous research, they've shown that older adults are more likely to incorrectly repeat an action in situations where a prospective memory task has become routine or habitual in nature.

Extending that line of research, the current study examines whether the tendency of older adults to err on the side of repeating a poorly remembered habitual task could be reduced by providing advance instructions to omit doing a task if in doubt about whether it was previously executed. The study also tested whether doing something unusual while executing a task would help seniors remember having done the task.

Specifically, participants were asked to push the F1 key on a computer keyboard once and only once at some point at least 30 seconds into a series of relatively simple, three-minute-long, letter-recognition tasks, such as pushing the computer key for the letter that comes next in the alphabet after a letter being displayed on the monitor (see a "g" and push an "h").

One subset of the older study participants was instructed to put a hand on their heads whenever they pushed the F1 key.

In another phase of the experiment, participants were asked to do the letter-recognition task while simultaneously carrying out an additional more complicated and distracting task listening to a series of random numbers and pushing a clicker whenever they heard two odd numbers in a row.

The performance of older adults averaging 72 years of age was compared with results from a group of college students put through the same trials.

"When ongoing task demands were challenging, older adults committed more repetition errors than younger adults, regardless of whether they'd been told in advance to err on the side of omission told not to push the F1 key if they had any doubt about whether it had already been pushed once in the same trial," says McDaniel.

However, older adults asked to carry out the more complex motor task (placing hand on head) while pushing the F1 key made significantly less repetition errors than older adults not making use of this memory enhancing technique.

And, in situations where the ongoing tasks were not overly complicated and distracting, older adults using this memory technique were able to reduce their repetition errors to levels comparable with those of younger adults.

This finding, along with other data from the study, suggests that older participants can learn to monitor their output and make better mental notes regarding the completion of a prospective memory task.

"For applied purposes, using a distinct motor activity to minimize repetition errors in older adults' prospective memory tasks would seem to have great potential. In light of these findings, it seems reasonable to conclude that, at least in a context in which the ongoing activity is not overly demanding, older adults can implement strategies that are effective for supporting execution and output monitoring of habitual prospective memory tasks," McDaniel concludes.

Source: Washington University in St. Louis