Overview
Introduction
At age 65 and beyond, a medication can become hazardous without any change in the prescription.
At age 65 and beyond, a medication can become hazardous without any change in the prescription. Age-related reductions in renal clearance and altered hepatic metabolism can raise drug exposure, while increased central nervous system sensitivity makes sedation, delirium, and falls more likely. Multimorbidity and polypharmacy then amplify these effects: one drug may worsen a symptom that is mistaken for a new disease, prompting a prescribing cascade. The American Geriatrics Society 2023 Beers Criteria is an explicit, consensus-derived list of medications that may be potentially inappropriate for older adults. Its tables address medications to avoid in most older adults, drugs that can worsen particular diseases or syndromes, medications requiring caution, clinically important drug-drug combinations, and agents requiring kidney-function-based dose adjustment or avoidance. A supplementary table identifies medications with strong anticholinergic activity. A Beers listing is a signal to reassess, not an automatic discontinuation order. The prescriber and patient must weigh indication, expected benefit, alternatives, treatment goals, function, life expectancy, and the person's preferences. The criteria support care in ambulatory, acute-care, and institutional settings, but they are not intended for hospice or...