Every year, thousands of older adults end up in the hospital because of a medication that shouldn’t have been prescribed in the first place. It’s not always a mistake-it’s often a standard practice that never got updated. The Beers Criteria exist to change that. Developed by the American Geriatrics Society and updated most recently in 2023, this list isn’t about banning drugs. It’s about recognizing when the risks of a medication outweigh its benefits for people over 65.
What the Beers Criteria Actually Do
The Beers Criteria are a living guide. They don’t say, "Never give this drug." They say, "For most older adults, this drug is more likely to cause harm than help." And they back that up with evidence from hundreds of studies.
Think of it like a warning sign on a road. It doesn’t mean you can’t drive there-it means you need to slow down, check your mirrors, and know the risks. The 2023 version includes 131 specific medication warnings. About 89 of those apply to nearly all older adults, no matter their health conditions. Another 22 target people with specific illnesses like dementia, kidney disease, or heart failure. And 20 are about how drugs behave when kidneys aren’t working well.
These aren’t random guesses. The expert panel reviewed over 1,500 studies published between 2019 and 2022 before updating the list. They looked at real outcomes: falls, confusion, kidney damage, bleeding, and even death. For example, antipsychotics like haloperidol or risperidone are now flagged more strongly because they increase the risk of stroke and sudden death in dementia patients. Benzodiazepines like diazepam or lorazepam? Still on the list-because they make falls and memory problems worse.
Why Older Adults Are More at Risk
It’s not just that older people take more pills. It’s that their bodies change. As we age, our liver and kidneys don’t process drugs the same way. Fat increases, muscle decreases, and fluid balance shifts. That means a drug that was safe at 50 can become dangerous at 75.
Take ibuprofen. For a younger person, it’s a quick fix for joint pain. For an older adult, it can cause stomach bleeds, raise blood pressure, or wreck kidney function. And it’s not just NSAIDs. Anticholinergics-common in some sleep aids, bladder meds, and even allergy pills-block a key brain chemical. That leads to confusion, memory loss, and even faster cognitive decline. A 2020 study found that long-term use of these drugs was linked to a 50% higher risk of dementia.
And then there’s polypharmacy. Nearly 40% of adults over 65 take five or more medications daily. That’s not because they’re overmedicated-it’s because they have multiple conditions. But each new drug adds another chance for interaction, side effects, or mismanagement. The Beers Criteria help cut through the noise by highlighting the biggest red flags.
What’s on the List (and What’s Not)
Here are some of the most common medications flagged in the 2023 Beers Criteria:
- Non-benzodiazepine sleep aids like zolpidem (Ambien) and eszopiclone (Lunesta)-linked to falls and confusion
- First-generation antihistamines like diphenhydramine (Benadryl)-strong anticholinergic effects
- Oral corticosteroids like prednisone-long-term use increases fracture risk
- Metronidazole-can cause nerve damage in older adults with kidney issues
- Proton pump inhibitors like omeprazole-overused for heartburn, linked to bone loss and infections
But here’s the catch: the list doesn’t say "never." For example, a person with severe arthritis and no kidney problems might still need an NSAID. Or someone with chronic insomnia might benefit from a low-dose sedative if other options have failed. The Beers Criteria don’t replace clinical judgment-they support it.
What’s missing from the list? Drugs that are safe for most older adults but still often overused. Think of insulin, blood pressure meds, or statins. These aren’t on the Beers list because they save lives. The problem isn’t the drugs themselves-it’s using the wrong ones, at the wrong dose, for the wrong reason.
How Clinicians Use the Beers Criteria
Most doctors don’t memorize the full list. That’s why the American Geriatrics Society made it easy to access: a free mobile app, a printable pocket card, and a searchable website at GeriatricsCareOnline.org. Pharmacists use it during medication reviews. Nurses use it to flag risky prescriptions in nursing homes.
Medicare and Medicaid require hospitals and nursing homes to track how often residents are prescribed Beers-listed drugs. That’s not to punish providers-it’s to find patterns. If a facility has 30% of patients on benzodiazepines, someone needs to ask why.
One study of older adults in long-term care found that 46% were taking at least one Beers-listed medication. After a pharmacist-led review, nearly half of those drugs were stopped or switched. No one got worse. Many got better-more alert, fewer falls, less dizziness.
The real power of the Beers Criteria comes when they’re part of a conversation. Not a rulebook. Not a penalty system. A tool for shared decision-making.
What Patients and Families Should Know
If you or a loved one is on multiple medications, ask: "Is this still necessary?" Don’t wait for a doctor to bring it up. Bring it up yourself.
Here are three simple questions to ask at your next appointment:
- Why was this medicine prescribed? What’s it supposed to do?
- Is this on the Beers Criteria list? If so, why are we still using it?
- What happens if we stop it? Are there safer alternatives?
Many older adults are afraid to stop meds-they think the doctor wouldn’t have prescribed them if they weren’t needed. But sometimes, a drug was started years ago and never reviewed. That’s where the Beers Criteria help. They give you a starting point for a conversation.
Don’t stop any medication on your own. But do ask. And if your doctor dismisses your concern, ask for a pharmacist consult. Many hospitals and clinics now offer medication reviews specifically for older adults.
Limitations and Misunderstandings
The Beers Criteria aren’t perfect. Critics say they’re too rigid. They don’t account for every individual’s situation. And yes-that’s true. A person with severe chronic pain might need a drug that’s on the list. A frail elderly person with no family support might need a sedative to sleep safely.
The American Geriatrics Society is clear: "This is not a blacklist." It’s a guide. A reminder. A way to pause and think before prescribing.
Some nursing homes use the Beers list to justify denying medications-even when they’re clearly needed. That’s a misuse. The criteria were never meant to restrict care. They’re meant to improve it.
There are other tools too, like STOPP-START, which looks at both inappropriate drugs and important ones that are missing. But Beers remains the most widely used because it’s simple, focused, and updated regularly.
What’s New in the 2023 Update
The 2023 version added more warnings about:
- Antipsychotics in dementia patients-stronger language, clearer risks
- Benzodiazepines and similar drugs-now linked to increased risk of hip fractures
- Drugs that lower blood pressure too much-especially in people prone to falls
- Drugs that affect the brain’s acetylcholine-more detailed warnings on cognitive harm
They also added new guidance on how kidney function changes with age. A drug that was safe when kidneys were normal can become toxic as kidney function declines. The new version includes specific creatinine clearance thresholds for when to avoid certain drugs.
And for the first time, the panel included input from older adults themselves-people living with multiple chronic conditions. Their feedback shaped how the language is written. It’s no longer just for doctors. It’s for patients too.
Next Steps: What to Do Now
If you’re caring for an older adult, here’s what you can do today:
- Get a complete list of all medications-including supplements and over-the-counter drugs.
- Check the Beers Criteria list at GeriatricsCareOnline.org. You don’t need to be a doctor to read it.
- Write down any medications that appear on the list.
- Ask the prescriber: "Is this still the best choice? Are there safer options?"
- Ask for a medication review with a pharmacist. Many insurance plans cover this.
Don’t wait for a crisis. Medication-related harm doesn’t always come with a siren. It creeps in slowly-more falls, more confusion, more fatigue. The Beers Criteria are your early warning system.
Final Thought
Medication safety for older adults isn’t about cutting pills. It’s about choosing wisely. It’s about knowing that less can sometimes be more. The Beers Criteria aren’t the whole answer-but they’re one of the most important tools we have. Use them not to control, but to care.
Are the Beers Criteria mandatory for doctors?
No, the Beers Criteria are not mandatory. They’re a clinical guideline, not a law. Doctors aren’t required to follow them, but they’re strongly recommended by major health organizations like the American Geriatrics Society, CMS, and AHRQ. Many hospitals and insurance programs use them as quality measures, so providers often do follow them to avoid penalties or improve care ratings.
Can a drug on the Beers list ever be appropriate?
Yes. The Beers Criteria say a drug is potentially inappropriate for most older adults-not all. There are exceptions. For example, a person with severe arthritis and no kidney disease might still benefit from an NSAID. Or a patient with advanced dementia and severe agitation might need a low-dose antipsychotic if other treatments have failed. The key is individualized care. The list helps flag risks so you can weigh them against benefits.
How often are the Beers Criteria updated?
The American Geriatrics Society updates the Beers Criteria every few years. The most recent version was published in 2023. Before that, updates came in 2019, 2015, and 2012. Updates are based on new research, especially studies published since the last version. The panel reviews over 1,500 new studies each time to ensure the list stays current.
Do the Beers Criteria apply to people under 65?
The Beers Criteria are specifically designed for adults aged 65 and older. While some medications on the list may also be risky for younger people with certain conditions (like kidney disease), the guidelines are not intended for that group. Other tools, like the STOPP-START criteria, can be used for younger adults with complex health issues.
Can I check if a medication is on the Beers list myself?
Yes. The full Beers Criteria list is free and publicly available at GeriatricsCareOnline.org. You can search by drug name or condition. There’s also a free mobile app from the American Geriatrics Society. You don’t need special training to use it. If you’re helping an older adult with their meds, it’s a good idea to check.
