The Beers List of Medications for Aging Adults: What to Know

Many aging adults have never heard of the Beers List of Medications, but this list is incredibly important in managing your health.

As we age, many of us often find ourselves grappling with chronic health conditions like high blood pressure, Diabetes, or Arthritis. The kidney, liver, and gastrointestinal tract also become less effective at filtering out toxins or substances. This includes the food you eat and the medications you take each and every day.

These natural changes alter the way our bodies absorb medications.

Bioavailability (how much of the drug your body is able to use versus how much is flushed out as waste) changes, as does the half-life (how long the drug stays in your system). What once worked flawlessly to treat your condition may actually become risky to take as you age, producing undesired side effects and dangerous complications.

The older you grow, the higher your risk of side effects.

The Beers List of Medications for Aging Adults was created to help you identify potentially dangerous medications and stay safe without jeopardizing your ability to treat conditions. Here’s what you need to know about it and how to use it to protect your health.

What is the Beers List of Medications?

Dr. Mark Beers and his colleagues first created what is now referred to as “The Beers List” back in 1991. Regulated by the American Geriatrics Society, the list receives regular updates every few years, with the last update formally published in 2015.

The Beers List of Medications is published as a tool for physicians. However, older adults and caregivers should be familiar with it. It is also available to the general public for anyone who wants to better understand their own pharmacological care.

The Beers List categorizes medications in three groups:

• Medications to avoid in all older adults
• Medications to avoid in older adults with certain medical conditions
• Medications that should be used cautiously with any older adult

These categories may be distinct, but they are also non-rigid. In some cases, a drug may be present in more than one category (such as older adults with certain medical conditions and cautious use) or just one.

The Most Commonly Mentioned Drugs

All drugs on the list have been graded by a panel of geriatric care experts who have also consulted the American College of Physicians’ Guideline Grading System. The grading system splits the drugs into high, moderate, or low risk categories, with different guidelines for testing and trial size for them to qualify.

1. Cardiovascular Drugs

Cardiovascular drugs are the most commonly-mentioned drug on the Beers List of Medications. As per CDC statistics, approximately 61 percent to 79 percent of individuals over the age of 65 have high blood pressure. Most take medication for it, but only a small percentage actually have their blood pressure completely under control.

Because high blood pressure is a warning sign of other potential heart issues, doctors must use caution when prescribing blood pressure medications to the elderly without doing a more in-depth investigation for other conditions. Some medications, like beta blockers or diuretics, are considered better first-line drugs for treating high blood pressure, while others, like clonidine, carry higher risks.

2. NSAIDs

The second most mentioned subcategory of drugs on the Beers List of Medications is Non-Steroidal Anti-Inflammatory Drugs (NSAIDs).

These are commonly prescribed for:

• Injury recovery
• Inflammation
• Swelling
• Pain
• Conditions like arthritis, but carry a significantly high risk for liver, kidney, and G.I. damage. This includes high blood pressure, stomach ulcers, and even perforations of the bowel.

In elderly patients, they may also cause dizziness and increase fall risk.

Over-The-Counter Drugs

It’s important to understand that the Beers List of Medications contains both over-the-counter medications and prescription drugs. Some of the most tried-and-true products you’ve been using most of your life may stop being safe once you reach a certain age.

Benadryl, for example, has been around for ages, yet it is on the list of drugs that no one over the age of 65 should take. This is largely because it causes sedation, clumsiness, and dizziness in some patients.

Specifically Mentioned Drugs to Avoid

There are dozens of drugs on the Beers List of Medications; but you’re probably more familiar with the drugs we’re about to cover here. From Naproxen to barbiturates like Fiorinal, here’s what to watch out for.

1. Naproxen

Individuals in high risk groups should avoid naproxen.

This is because of the potential risk for developing a GI bleed or a peptic ulcer. This is an over-the-counter pain reliever that helps with headaches, menstrual cramps, and other everyday aches and pains. Patients with arthritis and gout use this drug to control pain and swelling.

2. Diazepam

This drug should be avoided in older adults because they may be more sensitive to benzodiazepine drugs.

Risks include falls, cognitive impairment, and an increased chance of involvement in a car accident. This is a commonly-prescribed anti-anxiety medication that falls into the benzodiazepine family. It can also help to treat seizures, muscle spasms, and the symptoms of alcohol withdrawal.

3. Estrogen

Estrogens are on the Beers List because they may rarely raise the risk for heart attacks, strokes, breast cancer, and endometrial cancer.

Estrogen is part of a group of steroidal hormones that promotes the characteristics of female development; it also maintains them throughout life.

Older adults typically take estrogen supplements during and after menopause and/or to treat gender dysphoria, although the latter is much more common. These drugs may be available with or without additional progestins.

4. Testosterone

Men over the age of 65 should avoid testosterone supplements.

This is because they may have an excessive impact on the heart. Men who have had prostate cancer should be especially careful to avoid them, as testosterone feeds these cancers.

Testosterone is the hormone responsible for male characteristics; it declines as you age.

5. Antihistamines

You should avoid antihistamines altogether if you’re over 65 (including Benadryl).

Several drugs fall into this class, including brompheniramine, clemastine, doxylamine, meclizine, and triprolidine. The problem with these drugs is that they may increase your risk for confusion, dizziness, falls, and even delusions. This is especially true if you have early-onset Dementia.

While diphenhydramine is also on the list, it is a fairly safe option for severe allergic reactions.

6. Barbiturates

Barbiturates such as amobarbital, butalbital, and phenobarbital should be completely avoided.

Changing body composition makes seniors especially susceptible to dependence, but this is really only the beginning.

Barbiturate drugs are also intensely sedating. This can cause older adults to fall or even fall asleep while engaging in dangerous behavior (such as driving or using the kitchen stove). It is also extremely easy to overdose on this category of drugs, even if the dosage is low.

Conclusion

Feeling confused about what you can and can’t take? The Beers List of Medications can help you identify your risk factors and figure out which drugs you should be cautious about taking.

However, it’s important to note that your doctor is always your best line of defense.

If they suggest a drug, it’s because they judge the benefits to outweigh the risks – regardless of your age! Your pharmacist is your closest ally in wellness, especially when it comes to the medications you take each and every day.

Don’t be afraid to reach out to them and ask them to cross-check all of your medications each time you change or add a drug (including OTCs). It’s always better to be safe than sorry; your health is worth it.