Updated 2012 Beers Criteria: what's noteworthy and cautionary?

The Beers Criteria for potentially inappropriate medication use in older adults, originally published in 1991, have gone through several iterations.1 The initial publication focused exclusively on nursing home residents, providing a list of medications where the potential for harm exceeded the potential for beneficial effects. The criteria have arguably been influential in providing guidance for appropriateness of prescribing decisions in the elderly, especially for physicians and pharmacists practicing in long term care. In 1997 and again in 2003, the criteria were updated by a consensus panel of experts in geriatric pharmacotherapy who expanded the scope of the criteria and made it applicable for all adults aged 65 and older no matter where they reside and receive care.2,3 For more than a decade now, the Beers Criteria have been used as a clinical reference for informed decision making regarding prescribing in older adults. They have been used in several studies to predict health outcomes associated with potentially inappropriate medication (PIM) use in the elderly with variable andmixed results.4,5 The Beers Criteria also inform quality measures for several organizations and agencies, such as the National Committee for Quality Assurance, the Pharmacy Quality Alliance, the Centers for Medicare and Medicaid Services, and Medicare Part D. These bodies have relied on the criteria when developing quality measures addressing the pharmacological management of older adults.6 In 1999 and then again in 2006, the Centers for Medicare and Medicaid Services adopted some of the medications in the “Beers list” as quality indicator measures for assessing medication use in long term care facilities. The Beers Criteria have recently been revised by the American Geriatrics Society (AGS); this 2012 update,7 including several other tools and resources for public and professional use, are published on the AGS Web site.8 The 2012 Beers Criteria significantly improve on the previous methodology used in the past versions by using Institute of Medicine standards for clinical practice guidelines and a robust evidence-based grading system. The methodology and the literaturebased review are well characterized in the AGS publication.7 The structure and categorization of medications in tables remains essentially the same as in previous versions, with the exception of another table of medications to be used with caution. In essence, 53 medications or medication classes comprise the final updated criteria, and they are divided into 3 categories: PIMs and classes to avoid in