May 08, 2018
At the AGS Annual Meeting, panelists shared a glimpse of the methods used and some of the proposals being considered for the 2018 edition of the Beers Criteria for Potentially Inappropriate Use of Drugs in Older Adults.
First, Dr Steinman shared the methodological approach being used to develop the Criteria. He provided insight into how they are organized and some of the strengths and limitations of the recommendations. In contrast with the typical approach to clinical practice guideline development, the focus of the Criteria is on medications, rather than diseases, and on harms, rather than benefits, of particular treatments. Dr Steinman noted that research on harms is often limited, so while the Criteria are evidence-based, they are developed with a great deal of room for expert opinion.
A review of the literature published since the 2015 update was conducted, and the panel considered whether current criteria should be dropped or modified, or new criteria added, in light of this recent evidence. A margin of 90% agreement was needed to gain consensus on a recommendation.
Next, Dr Fick shared a preview of some of the changes that will be included in the 2018 edition, though she stressed that the new version is not yet final and still needs to undergo peer-review and public comment processes.
One of the changes included removal of a few rarely used drugs from the list of drugs to avoid. Some other drugs, including chronic seizure/epilepsy drugs, insomnia medications, vasodilators, and ACE inhibitors, were removed because it was determined that the concerns related to their use were not specific to older adults.
Some updates to the list of drugs to use with caution include the addition of DPP-4 inhibitors for patients with heart failure, the use of Nuedexta, and some of the indications for TMS (sulfamethoxazole/trimethoprim). It is now suggested that aspirin be used with caution in patients aged 70 years or older, rather than 80 years or older, and that both rivaroxaban and dabigatran be used with caution because of bleeding risk, whereas the previous guideline only cautioned against dabigatran.
The recommendations around the use of sliding scale insulin were modified to better clarify the definition of “sliding scale.” In general, Dr Fick noted that several updates were made to the caveats included in the recommendation in an effort to provide more clinical context for when drugs may not be appropriate.
Regarding drug-drug interactions, it is now suggested that CNS-active drugs not be combined with 2 or more other CNS-active drugs. The concurrent use of more than one potassium-raising medication should be avoided, reflecting a broadening of the previous criteria regarding these medications. It is also suggested that warfarin not be combined with several other drugs that can increase the risk of bleeding.
The 2018 version of the Beers Criteria are expected to be released in May or June 2018, at which time there will be a 2-week period for public comment before the recommendations are finalized.
For more Annals of Long-Term Care articles, visit the homepage
To view the Annals of Long-Term Care print issue, click here