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July 26, 2023
2023 Update to the AGS Beers Criteria®: The American Geriatrics Society (AGS) convenes an expert panel to regularly update the Beers Criteria, a list of potentially inappropriate medications for use by older adults (≥ 65 years) in most healthcare settings, except hospice and end-of-life care. Since the last update in 2019, a 12-member panel of interprofessional geriatrics experts used a systematic review and a modified Delphi method to prepare and publish the latest update in May 2023. The 2023 AGS Beers Criteria® includes 36 medications/classes with “avoid” recommendations and 8 classes to be used with caution, while removing 33 medications for low use or not being available in the United States. The 2023 AGS Beers Criteria® is designed to ensure safe medication use in older people and supports shared decision-making by patient-provider teams. Changes to the criteria are described in this update.
Upon completion of the chapter, the reader will be able to:
Explain changing aging population demographics.
Discuss age-related pharmacokinetic and pharmacodynamic changes.
Identify drug-related problems and associated morbidities commonly experienced by older adults.
Describe major components of geriatric assessment.
Recognize interprofessional patient care functions in various geriatric practice settings.
The growth of the aging population and increasing lifespan require healthcare professionals to gain knowledge necessary to meet the needs of this patient group. Despite the availability and benefit of numerous pharmacotherapies, older patients commonly experience drug-related problems, resulting in additional morbidities. Therefore, it is essential for clinicians serving older adults across all healthcare settings to understand the epidemiology of aging, age-related physiological changes, drug-related problems prevalent in elders, comprehensive geriatric assessment, and interprofessional approaches to care.
EPIDEMIOLOGY AND ETIOLOGY
As humans age, they are at increasing risk of disease, disability, and death for three reasons: genetic predisposition; reduced immunological surveillance; and the accumulated effects of physical, social, environmental, and behavioral exposures over the life course. Elders experience variably increasing vulnerability (homeostenosis) as they age, resulting in heterogeneity in health states and care requirements. While resilient elders can maintain high levels of physical and cognitive functioning, others suffer functional decline, frailty, disability, or premature death. There is an urgent need for clinicians to better understand the epidemiology of aging to comprehensively provide high-value services to optimize the function and health-related quality of life of older adults.1
The population is rapidly growing older. In 2020, 56.1 million US residents were 65 years and older, with projections to increase to 94.7 million by 2060.2 Almost 6.7 million people were 85 years or older (the “oldest-old”), and 100 thousand persons were aged 100 or older.2...