Beers Criteria: A Complete Medical Overview

Beers Criteria is a clinical tool that helps doctors identify medicines that may carry higher risks than benefits for many older adults. It does not automatically mean a medicine is wrong, but it supports safer prescribing by prompting a careful review of side effects, interactions, dose, and whether a better option may be available.

Overview: what Beers Criteria means

Beers Criteria is a widely used medical reference that helps clinicians recognize medications that may be more risky for many older adults. Developed by the American Geriatrics Society, it is designed for adults typically aged 65 and older and focuses on medicines that can cause more harm than benefit in some situations. The goal is not to deny treatment, but to support safer, more individualized prescribing.

As people age, the body often processes medicines differently. Kidney and liver function may change, body composition can shift, and the brain may become more sensitive to certain drug effects. Because of this, a medication that works well in a younger adult may cause more dizziness, confusion, constipation, low blood pressure, or sedation in an older person.

Beers Criteria is best understood as a screening tool rather than a strict rulebook. It helps doctors, pharmacists, patients, and caregivers ask practical questions: Is this medicine still needed? Is the dose suitable? Could it interact with another drug or worsen an existing condition? Is there a safer alternative? Used this way, it supports medication reviews that are thoughtful and balanced.

Why medication safety changes with age

Older adults are more likely to live with several health conditions at the same time, such as high blood pressure, diabetes, arthritis, sleep problems, bladder symptoms, or memory changes. This can lead to polypharmacy, a term used when a person takes multiple medicines regularly. While many medications are necessary and beneficial, combining several drugs can increase the risk of side effects and interactions.

Some medicines on the Beers Criteria list can affect alertness, balance, blood pressure, heart rhythm, or kidney function. In daily life, these effects may show up as falls, fainting, confusion, daytime sleepiness, difficulty urinating, constipation, poor appetite, or changes in mood. In some people, medicines can also contribute to delirium, a sudden change in attention and thinking that often needs prompt medical assessment.

Medication safety also depends on the full clinical picture. A person with frailty, kidney disease, a history of falls, or memory problems may be more vulnerable to harm from certain drugs. This is why Beers Criteria is often used alongside routine health checks, lab results, and assessment of conditions such as Alzheimer’s disease or balance-related concerns, rather than as a stand-alone list.

What kinds of medicines are included

Beers Criteria groups medications into several practical categories. These include drugs that are often best avoided in many older adults, medicines that may be inappropriate in people with specific health conditions, drugs that should be used with caution, combinations that can interact in harmful ways, and medicines that may need dose adjustment when kidney function is reduced.

Common examples often discussed in clinical practice include some sleep medicines, certain anti-anxiety drugs, older antihistamines, some pain medicines, some diabetes medicines, and drugs with strong anticholinergic effects. Anticholinergic medicines can sometimes cause dry mouth, blurred vision, constipation, urinary retention, and confusion, especially in older adults. Sedating medicines may also raise the risk of falls and injury.

The list is updated over time as medical evidence changes. This matters because the criteria reflects evolving research on benefits, harms, and safer alternatives. A medicine appearing in Beers Criteria does not mean it can never be used. In some cases, it may still be appropriate if the expected benefit is important and there is no better option, but that choice should be deliberate and closely monitored.

• Medicines best avoided in many older adults
• Medicines that may worsen certain conditions
• Medicines requiring caution because of side effects
• Drug combinations that increase interaction risk
• Medicines needing dose changes with reduced kidney function

How clinicians use Beers Criteria in real-life care

In practice, Beers Criteria is usually applied during a medication review. A doctor or pharmacist compares each prescription, over-the-counter medicine, vitamin, and herbal product against the person’s age, diagnoses, symptoms, kidney function, and treatment goals. This process is especially useful after a hospitalization, when a new symptom appears, or when a person begins seeing multiple specialists.

The review does not simply ask whether a medicine is on the list. It also considers why the drug was started, whether it is still helping, whether the dose is still suitable, and whether side effects might be mistaken for a new illness. For example, dizziness may be linked to a blood pressure medicine, and confusion may be related to sedating or anticholinergic drugs rather than to a primary neurological condition.

If concerns are identified, the next step may be observation, dose adjustment, switching to a safer option, or gradual deprescribing. Deprescribing means reducing or stopping a medicine that may no longer be needed or may be causing harm. This must be done carefully, because some medicines should not be stopped suddenly. In selected situations, the care team may recommend further evaluation with services such as check-up and screening to assess overall health, risk factors, and medication burden.

Benefits, limitations, and common misunderstandings

The main benefit of Beers Criteria is that it creates a clear, evidence-based framework for safer prescribing in older adults. It can help reduce preventable side effects, improve alertness and balance, lower the chance of drug interactions, and support conversations between clinicians, patients, and caregivers. It also encourages regular reassessment, which is important because medical needs often change over time.

At the same time, Beers Criteria has limits. It is not a list of forbidden medicines, and it does not replace clinical judgment. Some listed medications may still be the best choice for a particular person, especially when other options have not worked or when treatment goals are specific. The criteria also does not cover every possible prescribing issue, so doctors may use it together with other tools and guidelines.

A common misunderstanding is that any medicine on the Beers list should be stopped immediately. That is not safe advice. Sudden changes can cause withdrawal symptoms, worsening of the original condition, or other complications. Another misunderstanding is that the criteria applies to every adult; in fact, it was created for older adults and should be interpreted in the context of each individual’s health status.

What patients and families can do

Patients and caregivers can play an important role in safer medication use. Keeping an up-to-date medication list is one of the most helpful steps. This list should include prescription drugs, over-the-counter products, eye drops, inhalers, vitamins, and supplements. Bringing the list to every appointment can help the care team spot duplications, interactions, or medicines that are no longer needed.

It is also useful to watch for changes after starting or increasing a medicine. Symptoms worth noting include sleepiness, confusion, falls, constipation, dry mouth, trouble urinating, low appetite, shakiness, and new swelling. Sometimes these symptoms are subtle and may be mistaken for normal aging. Reporting them early can help prevent complications and may allow simple medication adjustments.

Questions that can support a productive appointment include: What is this medicine for? Is it still necessary? Are there safer alternatives for someone my age? Could it affect my balance, memory, or kidneys? If a medicine needs to be reduced, what is the safest plan? For some patients with ongoing age-related concerns, a clinician may also assess related conditions such as Parkinson’s disease or recommend support from teams experienced in neurology and medication-related symptoms.

• Keep a single updated list of all medicines and supplements
• Use one pharmacy when possible to reduce interaction risk
• Do not start or stop medicines without medical advice
• Ask about kidney function, fall risk, and memory-related side effects
• Request a medication review after hospitalization or when a new symptom appears

When to seek medical care

Medical advice should be sought promptly if an older adult develops sudden confusion, extreme sleepiness, fainting, chest symptoms, severe dizziness, trouble breathing, or a fall after starting or changing a medication. These symptoms may be related to the medicine itself, an interaction, dehydration, infection, or another medical problem that needs assessment. Urgent evaluation is also important if there is concern about overdose, double dosing, or withdrawal.

A non-urgent appointment is appropriate if a person has ongoing constipation, dry mouth, blurred vision, memory changes, repeated near-falls, poor sleep, or trouble managing a long medication list. These issues may signal that treatment can be adjusted to improve safety and quality of life. Even when symptoms seem mild, they are worth discussing, especially if several medicines are involved.

For international patients who need coordinated review and treatment, Acibadem International’s multidisciplinary specialists and JCI-accredited hospitals diagnose and manage medication-related concerns and the health conditions that may be affected by them. Depending on the situation, evaluation may involve internal medicine, geriatrics, cardiology, or internal medicine follow-up to guide safer prescribing.

Frequently asked questions

What is the Beers Criteria used for?

Beers Criteria is used to help identify medicines that may pose higher risks for many adults aged 65 and older. It supports safer prescribing by prompting a review of side effects, interactions, dose, kidney function, and whether a safer alternative may be available.

Does a medicine on the Beers Criteria list have to be stopped?

No. A listed medicine is not automatically wrong or unsafe for every person. Doctors consider the reason for treatment, expected benefits, side effects, and the person’s overall health before deciding whether to continue, change, or reduce a medicine.

Who should have a Beers Criteria medication review?

It is especially helpful for older adults who take several medicines, have had a recent hospitalization, have kidney problems, or have experienced falls, confusion, or new side effects. Caregivers may also request a review if managing medicines has become complicated.

What types of side effects can Beers Criteria help prevent?

The tool can help reduce risks such as drowsiness, confusion, falls, constipation, urinary retention, bleeding, and medication interactions. It may also support better dose selection in people with reduced kidney function.

Is Beers Criteria the same as a diagnosis?

No. It is not a disease or a diagnosis. It is a prescribing guide used by clinicians to review medication safety in older adults and to support more individualized treatment decisions.

Can over-the-counter medicines be a problem under Beers Criteria?

Yes. Some nonprescription products, including certain sleep aids, cold medicines, and antihistamines, can cause side effects that are more troublesome in older adults. These products should be included in any medication review along with vitamins and herbal supplements.

References

• American Geriatrics Society
• National Institute on Aging
• U.S. Food and Drug Administration
• Centers for Disease Control and Prevention
• World Health Organization

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.