Consider these common prescriptions: Sliding-scale insulin for a 68-year-old woman with diabetes; lorazepam (Ativan) for an 82-year-old man experiencing delirium; nitrofurantoin for a 78-year-old woman with a urinary tract infection.
Most pharmacists would be likely to accept the scripts without a second thought. Bad decision.
"Something needs to be said about the use of these agents in older adults," said Todd Semla, PharmD, associate professor, Clinical Medicine–General Internal Medicine and Geriatrics, and Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University. Semla is also a clinical pharmacy specialist with the Department of Veterans Affairs in Chicago. "Take benzodiazepines. The evidence is that short-acting benzodiazepines are also associated with falls, just like the longer-acting agents in the class."
What does Semla know that other pharmacists don't? "The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults."
He co-chaired the panel that revised the Beers Criteria under the aegis of the American Geriatrics Society (AGS) earlier this year. The Criteria list more than a dozen drugs and therapeutic classes that should be used with caution in older adults — as well as dozens of agents that should be avoided in most geriatric patients.
"One of the overarching achievements is that we took on an evidence-based approach to evaluating drugs that may be inappropriate in older adults," Semla said. "Our ultimate goal with the Beers Criteria is to improve the care of our patients."