Beers Criteria: What It Is and Why It Matters for Older Adults

When you’re over 65, your body handles medicine differently. That’s where the Beers Criteria, a regularly updated list of medications that may be unsafe for older adults. Also known as the AGS Beers Criteria, it’s used by doctors, pharmacists, and caregivers to avoid drugs that increase fall risk, confusion, kidney damage, or even death in seniors. This isn’t about banning meds—it’s about replacing the wrong ones with safer choices.

The Beers Criteria, a regularly updated list of medications that may be unsafe for older adults. Also known as the AGS Beers Criteria, it’s used by doctors, pharmacists, and caregivers to avoid drugs that increase fall risk, confusion, kidney damage, or even death in seniors. isn’t just a checklist. It’s a warning system built from real-world harm. Take diphenhydramine—the sleepy-time pill in Benadryl and many OTC sleep aids. It’s common, cheap, and easy to get. But in older adults, it blocks acetylcholine, a brain chemical needed for memory and focus. That’s why it’s flagged in the Beers Criteria: it can cause confusion, dry mouth, constipation, and even delirium. The same goes for long-term benzodiazepines like diazepam. They’re prescribed for anxiety or insomnia, but they raise fall risk by 50% in people over 65. The Beers Criteria says: avoid these unless there’s no other option.

Another big issue is polypharmacy, the use of multiple medications at once, common in older adults with several chronic conditions. When someone takes five, six, or ten pills a day, interactions become a silent threat. A heart pill might clash with a painkiller. An antacid might stop a bone drug from working. The Beers Criteria helps cut through the noise by highlighting the most dangerous combinations. It also points out drugs that are outdated—like meperidine for pain. It’s still in some formularies, but it builds a toxic brain chemical called normeperidine. That’s why it’s on the list: it’s not just ineffective for seniors, it’s risky.

What’s missing from the list matters too. The Beers Criteria doesn’t just say what to avoid—it guides you toward better alternatives. For example, instead of sleeping pills, it recommends sleep hygiene and CBT-I. For chronic pain, it pushes physical therapy and acetaminophen over NSAIDs like ibuprofen, which can wreck kidneys or cause stomach bleeds in older bodies. It’s not about cutting meds—it’s about smart replacements.

You’ll find posts here that dig into specific drugs flagged by the Beers Criteria—like why certain anticholinergics are dangerous, or how OTC cold meds can trigger dangerous spikes in blood pressure for seniors on certain heart drugs. You’ll also see comparisons between older, risky options and modern, safer ones. This isn’t theory. These are real prescriptions that real people are taking. And with more than half of seniors on five or more medications, getting this right isn’t optional—it’s life-saving.