Key Changes in 2023 AGS Beers Criteria for Inappropriate Medications in Older Adults

The 2023 AGS Beers Criteria update introduces significant modifications and new recommendations impacting antihyperglycemics, anticoagulants, anticholinergics, and select drug–disease interactions for older adults.

AGS Beers CriteriaAmerican Geriatrics Societygeriatricspotentially inappropriate medicationsanticoagulantsanticholinergicsdiabetes agents Beers Criteria

Authors: By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel

Citation: By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society. 2023;71(7):2052-2081. doi:10.1111/jgs.18372

Article Links: PubMed · Journal / DOI · Free Full Text (PMC)

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Practice-changing Impact 3/5

The 2023 AGS Beers Criteria update alters common therapeutic selections for older adults and expands the avoid category for several high-risk drug classes, requiring immediate changes in medication review and prescribing practices.

Evidence Grade: Moderate

Most recommendations are based on systematic reviews or large observational studies in older adults, but limitations in clinical trial representativeness preclude a high-certainty rating.

What's New / Changed vs. Prior Version

Key updates in the 2023 AGS Beers Criteria include expanded proton pump inhibitor (PPI) criteria, revised anticholinergic burden considerations, and new entries for tramadol risks. Additionally, caution is advised for meclizine regarding fall risk, rivaroxaban in chronic kidney disease (CKD), and guidance on GLP-1 receptor agonist monitoring is introduced. Hypnotic/sleep medication criteria have been revised to address melatonin receptor agonists, and there is updated guidance on Z-drugs.

Key Recommendations

The criterion for proton pump inhibitors has been expanded to address long-term use risks (Class IIa, Level B). Anticholinergic burden should be minimized due to cognitive risk, emphasizing the need for alternative therapies (Class I, Level A). Tramadol is now noted for potential increased fall risk, advising caution (Class IIa, Level B). Meclizine is discouraged in older adults due to fall risk potential (Class I, Level A). Rivaroxaban is cautioned against in severe CKD cases due to bleeding risk (Class IIb, Level C). The recommendation introduces monitoring for GLP-1 receptor agonists when used in older adults (Class I, Level B). Hypnotics, including Z-drugs, should be minimized due to risks outweighing benefits in older populations (Class I, Level A).

Practice Impact for Pharmacists

Review and adjust PPI prescriptions for long-term use in older adults.
Assess patient medication regimens for anticholinergic burden and consider alternatives.
Exercise caution with tramadol usage due to increased fall risk.

Implementation Considerations

Adjusting prescribing habits may require changes to electronic health record order sets and prescriber education. Monitoring for GLP-1 receptor agonists will need clear protocols, potentially increasing clinical workload. Access to alternative therapies for anticholinergics necessitates collaboration with prescribers and possibly higher costs.

Controversies / Dissenting Opinions

None noted

Full text source: Drive Reprocess – AGS 2023 Beers Criteria Update