On Aug. 18, the American Geriatrics Society released a critical update to the 2023 AGS Beers Criteria list of alternatives to medications — the most widely adopted guidelines to help clinicians identify potentially inappropriate medications for older adults.
Journalists can use some of the suggestions in the revised Beers Criteria and linked articles below to report on the dangers of polypharmacy, help educate their audiences about the importance of discussing medication management with health providers and remind physicians to consider non-pharmacologic alternatives for their older patients.
They can also check hospital and nursing home data to learn whether patients are being over-medicated, treated for polypharmacy-related side effects or being offered non-drug options.
More about the guidelines
The Beers Criteria identifies medications that are more likely to harm than help older adults due to side effects such as sedation, falls, delirium and interactions with other conditions. Criteria apply to adults 65 and older in ambulatory, acute and institutionalized care settings, except for hospice and end-of-life care settings. The Beers Criteria was developed to provide clear, consistent guidelines by symptom or diagnosis, supplemented by links to reliable resources for both health professionals and the public.
“Clinicians, patients and caregivers need guidance not only on what therapies to avoid, but on alternative non-pharmacologic and pharmacologic treatment strategies to consider in place of such potentially inappropriate medications,” the authors said. This new effort presents evidence-based recommendations for common conditions experienced by frail and aging populations.
Why this matters
Polypharmacy is common among older adults, many of whom have multiple chronic conditions — such as arthritis, asthma, chronic obstructive pulmonary disease, heart disease, depression, diabetes and hypertension. But taking too many drugs can be unsafe due to side effects.
A CDC report found that nearly 84% of U.S. adults in their 60s and 70s had used at least one prescription drug in the previous 30 days and about one-third used five or more prescription drugs. Yet, some physicians may be reluctant to deprescribe medications or do not consider non-pharmacological approaches as a first step. This can lead to increased health costs, preventable hospitalizations and diminished quality of life, according to a study in The Lancet.
“This approach is further operationalized into hazardous drug combinations, unacceptable pill burden, difficulty with medication adherence, or when medications are being prescribed as part of a prescribing cascade, in which drug side-effects are misinterpreted as a new medical condition, leading to additional medications,” the Lancet authors said.
In addition to serious side effects, overmedication can also lead to misdiagnosis, especially when it comes to cognitive issues. Impairment can actually be a result of medication side effects and not true decline, according to geriatrician Ariel Green, M.D., Ph.D., MPH, associate professor of medicine at the Johns Hopkins University School of Medicine.
Pushback from some patients
However, addressing polypharmacy may be more challenging than it appears. While physicians are supposed to conduct a medication review as part of the annual Medicare wellness visit, a study by University of Michigan researchers found that when they suggested reducing the number of medications, many patients were reluctant to do so, for fear of their condition worsening.
The new Beers criteria offers physicians an updated list of alternative therapies to consider in place of commonly prescribed medications and presents information in a way that older patients might be open to — such as strategies for improved sleep hygiene techniques rather than a prescription sleeping aid.
The AGS panel is a multidisciplinary cohort of 19 national experts from 14 states: physicians, pharmacists, nurses, psychologists and physical therapists. Experts systematically reviewed and curated alternatives for some of the most challenging prescribing scenarios faced in geriatric practice.
“We see the risks of potentially inappropriate medications play out in the emergency rooms, clinics, nursing homes or when families are struggling at home,” said panel member and Purdue University professor Noll Campbell, PharmD, M.S. “Our aim with this document is to provide support beyond saying ‘don’t prescribe,’ by offering clinicians, patients and families with a list of credible, actionable alternatives — whether it’s a safer medicine or a proven lifestyle approach.”
New feature
A new feature of the updated criteria is the inclusion of patient and caregiver-friendly materials, such as decision aids and handouts on deprescribing, and support for making lifestyle changes.
“We recognize that simply removing a medication may not be enough, especially if symptoms return or worsen,” said Campbell. “Our intent is to provide practical, prioritized alternatives that can be started or considered right away, so that care is both safer and responsive to what matters most to older adults.”
Resources
- The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, Cleveland Clinic.
- Polypharmacy and deprescribing among geriatric patients, Health and Aging Research (2025).
- Polypharmacy Management in Older Patients, Mayo Clinic Proceedings (2021).
- Deprescribing To Reduce Medication Harms in Older Adults, National Library of Medicine (2024).
- Deciding When It’s Better to Deprescribe Medicines Than to Continue Them, JAMA (2023).
