The Beers Criteria: What Seniors Should Avoid in Medications

Every year, thousands of seniors end up in the hospital because of medications that were supposed to help them. Not because they took too much, but because they took the wrong ones. The American Geriatrics Society’s Beers Criteria exists to stop this. It’s not a suggestion. It’s a science-backed list of drugs that pose more risk than benefit for people 65 and older. And it’s updated every three years with new evidence - the latest version came out in May 2023 after reviewing over 7,000 studies.

What the Beers Criteria Actually Does

The Beers Criteria doesn’t say “never use this drug.” It says: “For most older adults, the risks of this drug outweigh the benefits.” That’s a critical difference. It’s about context - age, health conditions, kidney function, and what else you’re taking.

The 2023 version lists 134 medications or drug classes that should be avoided or used with extreme caution. That’s 32 new entries since 2019. Some were added because new studies showed they cause more falls, confusion, or kidney damage in seniors. Others were removed because safer alternatives became available.

It’s organized into five clear sections:

1. Drugs that are generally inappropriate for older adults
2. Drugs to avoid if you have certain conditions
3. Drugs that need caution - even if they’re not outright banned
4. Drug combinations that are dangerous together
5. Drugs that need dose changes if your kidneys aren’t working well

Common Medications on the Avoid List

Some of the most surprising entries aren’t obscure drugs - they’re the ones you’ve seen on TV ads or bought over the counter.

First-generation antihistamines like diphenhydramine (Benadryl) and hydroxyzine are flagged because they block acetylcholine - a brain chemical needed for memory and focus. In seniors, this leads to confusion, dry mouth, constipation, and even delirium. Studies show these drugs increase dementia risk over time. Yet, millions still take them for allergies or sleep.

Benzodiazepines like diazepam (Valium) and lorazepam (Ativan) are another major concern. They’re prescribed for anxiety or insomnia, but they slow reaction time, increase fall risk by 50%, and can cause memory loss. Since the 2023 update, the criteria strongly recommends non-drug options like cognitive behavioral therapy for insomnia instead.

NSAIDs - including ibuprofen and naproxen - are risky for seniors with heart failure, high blood pressure, or kidney disease. They can cause fluid retention, spike blood pressure, and damage kidneys even at low doses. Acetaminophen is usually a safer pain option, but even that needs dosing adjustments if liver or kidney function is low.

Antipsychotics like risperidone and haloperidol are listed as inappropriate for dementia-related aggression or psychosis - unless other treatments have failed and the person is a danger to themselves or others. Even then, they should be used at the lowest dose for the shortest time possible.

Why the Beers Criteria Matters More Than Ever

Seniors make up just 13.5% of the U.S. population, but they take 34% of all prescription drugs. That’s because many have multiple chronic conditions - arthritis, diabetes, heart disease - and each condition brings its own medication. This is called polypharmacy, and it’s the main reason drug-related hospitalizations in older adults are so high.

The Beers Criteria helps cut through the noise. A 2021 study found that when doctors used the criteria to review prescriptions, adverse drug events dropped by 28%. That means fewer falls, fewer ER visits, fewer stays in the hospital.

It’s also built into Medicare’s system. If you’re on Medicare Part D and take eight or more medications, your pharmacy must review your list using the Beers Criteria. That’s not optional - it’s federal policy.

How Doctors and Pharmacists Use It

Most hospitals and clinics now have the Beers Criteria built into their electronic health records. When a doctor prescribes a flagged drug, the system pops up a warning. But here’s the catch: many providers get alert fatigue. One survey found doctors see an average of 12 Beers-related alerts per patient visit. That’s overwhelming.

Pharmacists, on the other hand, report high satisfaction. In comprehensive medication reviews, they use the Beers Criteria to spot hidden risks - like a patient taking three anticholinergic drugs at once, or gabapentin at a dose that’s too high for their kidney function.

The 2025 update added something new: the Alternatives List. For every flagged medication, it now suggests safer options. For example:

• Instead of diphenhydramine for sleep → try melatonin or sleep hygiene habits
• Instead of NSAIDs for arthritis → physical therapy, topical capsaicin, or low-dose acetaminophen
• Instead of benzodiazepines for anxiety → CBT, mindfulness, or buspirone

These aren’t just guesses. Each alternative is backed by clinical trials.

Limitations and Criticisms

No tool is perfect. The Beers Criteria has been criticized for being too rigid. For example, it says antipsychotics shouldn’t be used in dementia - but what if a patient is violent, hallucinating, and other treatments have failed? In palliative care, sometimes the goal isn’t to avoid all risk - it’s to relieve suffering.

Another issue: cost. One study found 25% of seniors skip medications because they’re too expensive. The Beers Criteria doesn’t tell you what to do when the safe alternative costs $300 a month and the flagged drug costs $10. That’s a real-world problem doctors face daily.

Also, the criteria doesn’t always account for how well a drug works for an individual. A senior might tolerate a drug others can’t. That’s why it’s a guide - not a rulebook.

What You Can Do

If you or a loved one is over 65 and takes multiple medications:

• Ask your doctor: “Are any of these on the Beers Criteria list?”
• Ask your pharmacist to do a full medication review - it’s free with Medicare.
• Don’t stop any drug without talking to your provider. Some meds need to be tapered.
• Use the free AGS Beers Criteria mobile app. It’s updated quarterly and works offline.

Most seniors don’t know their meds are being checked against the Beers Criteria. A 2023 survey found only 39% of older adults were aware of it. That’s a gap. You have the right to know why a drug is being prescribed - and whether there’s a safer option.

The Bigger Picture

The Beers Criteria isn’t just about avoiding bad drugs. It’s about shifting the mindset in geriatric care. Instead of adding a pill for every symptom, we’re learning to ask: “What’s the least risky way to help?”

The FDA has already required 17 Beers-listed drugs to add stronger warnings for seniors. Pharmaceutical companies are developing new drugs designed specifically for older adults - a market projected to hit $84 billion by 2027.

And in the future, AI tools are being trained to predict which seniors are most at risk from flagged medications - before they even get the prescription.

The goal isn’t to eliminate all medications. It’s to make sure every pill you take is truly necessary, safe, and right for your body - not just your diagnosis.