This excerpt is reposted with permission from Dr. Leslie Kernisan and BetterHealthWhileAging.net. You can find the original full article here: Medications Older Adults Should Avoid or Use with Caution: The American Geriatrics Society Beers Criteria (2019 Update).
If you’re an older adult, or if you’re involved in the medical care of an aging relative, what can you do?
Dr. Steinman’s advice, which he shared in the recent podcast episode, is to be proactive.
Although we do have a lot of information available regarding which medications are risky for older adults, and how to manage medications more safely, it’s still very common for older adults to experience inappropriate prescribing and also harms from their medications.
Most health providers are well-intentioned and caring. But they’re also often lacking the time, resources, and supportive systems they need to be more careful about medications.
So for now, if you want to improve your chances of using medication carefully, here are some suggestions:
Review your medications, and try to find out if any are listed in the Beers Criteria. Pharmacists can be a good resource, if you want help spotting these medications.
- If you are taking a Beers list medication, HealthinAging.org offers a helpful resource here: What To Do And What To Ask If A Medication You Take Is Listed In The AGS Beers Criteria® For Potentially Inappropriate Medication Use In Older Adults.
Always ask questions when a new medication is being prescribed, to make sure you understand why a medication is being prescribed and to confirm that it makes sense to proceed with this medication. Good questions for older adults to consider asking include:
- Could this medication affect my balance or my thinking?
- Is this medication listed in the Beers Criteria?
- Can you please review with me what is the expected benefit of this medication, and what are the likely risks?
- Are there any safer or non-drug approaches to treatment that I should be aware of?
- Are there any particular side-effects I should look out for?
Ask to review medications after hospital discharge or a move from one healthcare location to another. Many medications prescribed during hospitalization may not need to be continued long-term.
- Your usual health provider will be more likely to carefully review your post-discharge medications if you request this.
- If you don’t have a usual health provider, you can still request an appointment with a doctor, nurse, or pharmacist, to carefully review medications and discuss whether each is still likely to be beneficial.
Ask to schedule regular medication reviews with your health provider. Most experts recommend regular medication reviews for older adults.
- I suggest yearly medication reviews, especially for older adults who are taking any medications listed in the Beers Criteria, or who take more than 5 medications.
- I share a five-step process to help you prepare for a useful medication review here.
Regularly ask about deprescribing. Remember that when it comes to older adults and medications, less is often more. Deprescribing means reducing or stopping medications that may not be beneficial or may be causing harm, to maintain or improve quality of life.
- For more on deprescribing, see this article, which includes links to a series of excellent consumer guides to help older adults discuss deprescribing of benzodiazepines, NSAIDs, proton-pump inhibitors, antipsychotics and more.
- Deprescribing is much more likely to happen when older adults and families ask about it. So ask!
I know it can seem a bit daunting to start asking a lot of questions about your medications, or your older parents’ medications.
I also know that although many health providers will welcome your questions and be glad to see you participating in your care, others might give you a hard time, because they’re busy or maybe they just aren’t used to having to think over what they are prescribing.
Nonetheless, I want to encourage you to do it anyway! Yes, it can be a little extra work, but it’s your health and safety at stake. (Plus there’s your wallet, paying all those co-pays.)
Many older adults do need to be on medication. And, many of them are on more medication than is truly necessary.
You don’t have to be one of them.
You now know about the AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. You know that every few years, an ace team of experts is reviewing the medical literature and coming up with a carefully chosen list of medications that older adults should avoid, or use with caution.
Even if you don’t get a copy of the most recent AGS Beers Criteria, you can follow the suggestions listed above.
Find out if any of your medications are listed in the Beers Criteria. Ask about alternatives. Review medications regularly. Get medications deprescribed when possible.
With just a little bit of effort, I know that you will vastly improve the odds that whatever medications you — or your older relative — are taking are truly serving your health, and not exposing you to unnecessary risk.
