Beers Criteria® – Pharmacology across the Lifespan (Nursing)

00:01 Hi, I'm Dr. Rhonda Lawes.

00:03 And in this video we're going to take a look at Beers Criteria.

00:06 Now the beers criteria are a guide for increasing the safety of medication administration for older adults.

00:13 So let's take a look at what we're going to examine overall.

00:16 The main concepts we'll cover in this video will be the history of the criteria and their purpose.

00:21 We'll talk about how it's used in the healthcare environment, and help you remember, which older adults are at highest risk by using the acronym.

00:29 Finally, we'll talk about advocating for older adults in using the criteria.

00:35 The history of the criteria and their purpose.

00:37 Well, these beers criteria are published by the American Geriatric Society or the AGS.

00:43 Now these criteria are based on the best understanding of the research evidence at the time they're published.

00:49 Now, these are essential for nurse practitioners and RNs caring for geriatric patients.

00:55 So the recommendations are intended for general information only.

00:59 They're not considered medical advice, but they should be something that's considered in your care of geriatric clients.

01:05 So these don't replace professional medical advice like an APRN or a physician.

01:11 You always want to make sure if there's a specific condition, these are just guidelines.

01:17 If you're not familiar with the Beers Criteria, it's meant to be utilized in the healthcare environment.

01:22 This list, the beers criteria, is an evolving list of potentially inappropriate medications for older adults.

01:29 You may see them in the literature as PIMS, P-I-M-S.

01:33 Now, healthcare providers like nurse practitioners are advised to avoid prescribing these medications whenever possible.

01:40 The rationale is because of the increased risk of adverse effects and therefore that makes them of limited therapeutic benefit.

01:48 There's five major area of adverse side effects.

01:52 I want to make sure that you're familiar with when we're talking about the negative effects or adverse effects of medications in the geriatric population.

01:59 These include orthostatic hypotension, urinary and bowel retention, sedation, and esophageal irritation.

02:08 So these are particularly problematic in the geriatric population, and especially with those who have chronic conditions.

02:16 Now knowing which older adults are at high risk, that's what the Beers Criteria is all for.

02:21 B stands for Benefit.

02:23 So you want to ask yourself as a nurse practitioner, does the medication have a positive effect on the health outcomes? For example, if the medication is used to treat high blood pressure, it should lower the blood pressure.

02:35 Now the E is for Efficacy.

02:37 Is the effect of the medication consistent and robust across multiple studies.

02:42 For example, multiple randomized control trials should show that the medication is effective in lowering blood pressure.

02:48 Now the next E stands for Evidence.

02:51 What is the quality and quantity of evidence supporting the medication? For example, the evidence for the medication could include multiple large high quality randomized controlled trials, meta analysis and observational studies.

03:05 R stands for Risks.

03:08 What are the potential side effects or harm associated with the medication? For example, the medication may cause headaches, dizziness, or nausea.

03:17 The risk benefit ratio should be evaluated to determine if the potential benefits outweigh the risks.

03:24 In your downloadable materials, you'll see the latest copy of Beers Criteria.

03:28 But I want to cover three categories and bring those to your attention.

03:33 Avoidance of long-term use benzodiazepines in the geriatric population is one of the most important on the list.

03:41 So you don't want to use these for anxiety or insomnia because of the risk of side effects in geriatric patients.

03:47 In addition, you can be struggling with addiction and withdrawal and the interactions of benzodiazepines with other medications, and many older adults are taking multiple medications.

04:00 The second group, Nonsteroidal anti-inflammatory drugs, Even if the patient does not have kidney damage, using NSAIDs for chronic pain, like ibuprofen or naproxen are associated with a higher risk of stomach irritation that can be particularly dangerous to the older adult.

04:17 The third category I wanted to address are anticholinergic, such as some tricyclic antidepressants and antihistamines.

04:25 If they're being used for conditions like urinary incontinence or allergies these can result in urinary and bowel retention in the geriatric client.

04:33 This would increase the risk for infection and obstruction.

04:36 So let's wrap up this video series.

04:39 The Beers Criteria provide recommendations but does not overrule individual clinician assessment and judgment.

04:46 However, clinician should document considerations of the risk benefit ratio of using medications on the Beers list.

04:53 So whether you're an advanced practice nurse practitioner, or an RN nursing student, your knowledge of the Beers list can make a significant difference in the lives of your geriatric patients.