Beers: The list to know if you’re 65 and older

As we get older, our bodies turn against us. Our blood pressure starts to rise, knees develop arthritis and arteries start to clog up. And we take more and more medications. According to drug company Merck, 90% of people over the age of 65 take at least one medication per week, and 40% take five or more. With this comes a scary inevitability: 1 in 6 people in this age group will experience a harmful side effect of a drug they are taking regularly.

Thankfully, a database developed by the American Geriatrics Society (AGS) aims to prevent bad drug interactions and side effects in those over the age of 65 by flagging drugs that are inappropriate for older people. The challenge is getting doctors to use it.

Why are some drugs dangerous when used by older people?

Older people are twice as likely to experience medication side effects than younger people. That’s primarily due to three main reasons:

First, as we age, our body composition changes. We lose water and gain fat, which means water-soluble drugs don’t properly dilute while lipid-soluble drugs nestle into our fat layers and are absorbed faster. In both cases, the concentration of the drug inside the body increases, which boosts the chances of side effects. With more of a drug circulating within the body, medications can also interact with things like other drugs, certain foods or alcohol.

Second, two of the organs that break down medications, the liver and the kidneys, do not operate as efficiently in older people as in younger people. When our metabolism decreases, drugs stay in our system longer, which can also lead to increased side effects.

Third is the simple fact that older people take so many more drugs than younger people. More drugs in the body means more risk.

Beers Criteria

The Beers list, named for its creator, Dr. Mark Beers, was first released in 1991; the most recent version came out in 2015. The list is meant for physicians prescribing drugs to older individuals, but it’s also a good reference for patient education.

Let’s take a closer look at some drug categories that are included in the Beers List 2015.

Cardiovascular drugs
It’s quite common for older people to have chronic high blood pressure (hypertension). In fact, according to the CDC, 64–79% of people over the age of 65 have it. What’s more, only roughly 30% of older people hold their blood pressure in check with treatment, whether through lifestyle alterations or medication intervention.

Because high blood pressure and advancing age are telltale warning signs of a potential cardiac event, such as a heart attack or stroke, physicians should consult the Beers Criteria when prescribing hypertension drugs to older patients. According to the list, older people should avoid taking Kapvay (clonidine) as a first-line medication against high blood pressure. Luckily, there are a number of other choices available to discuss with your doctor including: diuretics, ACE inhibitors or beta blockers. (Read the full list of available high blood pressure meds here.)

Anti-anxiety drugs
Benzodiazepines (“benzos”) are commonly used to treat anxiety. However, not all benzos are created equal. Beers recommends that older patients avoid this class of meds, except in particular circumstances. If prescribed to older adults, clinicians will want to use the lowest therapeutic dose, so there’s less medicine coursing through the body at any given time. That’s because there are exacerbated side effects when it comes to benzos in older populations, such as cognitive impairment, feeling tired or having delayed reaction time.

Some benzos, like Klonopin (clonazepam), have a longer half-life in the body compared to preferable shorter-acting medications such as Ativan (lorazepam) and Xanax (alprazolam). Though they clear the body rapidly, Ativan and Xanax are still quite potent, which may increase toxicity in older people. If someone over the age of 65 absolutely needs to take a benzodiazepine, one report suggests using a short-acting, less potent drug like Serax (oxazepam) instead.

Pain relief drugs
Non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen are some of the most commonly used medications, and are available over-the-counter or by prescription, depending on the dose. However, older people are recommended to use these drugs only for temporary purposes as they can have nasty side effects, including gastrointestinal bleeding.

It’s well-documented that NSAIDs can take a toll on the liver and kidneys of older patients, increase their blood pressure, and cause headaches or dizziness. They also increase the risk and severity of peptic ulcers in the aging population.

If not properly addressed, the side effects could be serious enough to warrant a trip to the emergency room or an overnight stay at the hospital.

In all, the Beers list covers dozens of conditions and hundreds of medications. A PDF of the full 2015 Beers Criteria can be found here. Some of the drugs on the list you may have never heard of — especially if you fall outside the age 65 or older group, they may not be on your radar.

It may be surprising how many common drugs are on the list — including some OTC meds, which people generally assume are safer than prescription drugs. For example, the first-generation antihistamine, Benadryl (diphenhydramine), is listed as a no-no in the Beers Criteria. These landmines are exactly why physicians should make their patients aware of Beers Criteria as they get older.

And it’s why older people should also be aware of the Beer’s list. After all, your doctor won’t be at the pharmacy or supermarket to help you figure out which OTC medications to avoid.