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 Societyâs Beers Criteria exists to stop this. Itâs not a suggestion. Itâs a science-backed list of drugs that pose more risk than benefit for people 65 and older. And itâs 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 doesnât say ânever use this drug.â It says: âFor most older adults, the risks of this drug outweigh the benefits.â Thatâs a critical difference. Itâs about context - age, health conditions, kidney function, and what else youâre taking. The 2023 version lists 134 medications or drug classes that should be avoided or used with extreme caution. Thatâs 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. Itâs organized into five clear sections:- Drugs that are generally inappropriate for older adults
- Drugs to avoid if you have certain conditions
- Drugs that need caution - even if theyâre not outright banned
- Drug combinations that are dangerous together
- Drugs that need dose changes if your kidneys arenât working well
Common Medications on the Avoid List
Some of the most surprising entries arenât obscure drugs - theyâre the ones youâve 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. Theyâre 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. Thatâs because many have multiple chronic conditions - arthritis, diabetes, heart disease - and each condition brings its own medication. This is called polypharmacy, and itâs 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. Itâs also built into Medicareâs system. If youâre on Medicare Part D and take eight or more medications, your pharmacy must review your list using the Beers Criteria. Thatâs not optional - itâs 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 hereâs the catch: many providers get alert fatigue. One survey found doctors see an average of 12 Beers-related alerts per patient visit. Thatâs 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 thatâs 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 â try melatonin or sleep hygiene habits
- Instead of NSAIDs for arthritis â physical therapy, topical capsaicin, or low-dose acetaminophen
- Instead of benzodiazepines for anxiety â CBT, mindfulness, or buspirone
Limitations and Criticisms
No tool is perfect. The Beers Criteria has been criticized for being too rigid. For example, it says antipsychotics shouldnât be used in dementia - but what if a patient is violent, hallucinating, and other treatments have failed? In palliative care, sometimes the goal isnât to avoid all risk - itâs to relieve suffering. Another issue: cost. One study found 25% of seniors skip medications because theyâre too expensive. The Beers Criteria doesnât tell you what to do when the safe alternative costs $300 a month and the flagged drug costs $10. Thatâs a real-world problem doctors face daily. Also, the criteria doesnât always account for how well a drug works for an individual. A senior might tolerate a drug others canât. Thatâs why itâs 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: âAre any of these on the Beers Criteria list?â
- Ask your pharmacist to do a full medication review - itâs free with Medicare.
- Donât stop any drug without talking to your provider. Some meds need to be tapered.
- Use the free AGS Beers Criteria mobile app. Itâs updated quarterly and works offline.
The Bigger Picture
The Beers Criteria isnât just about avoiding bad drugs. Itâs about shifting the mindset in geriatric care. Instead of adding a pill for every symptom, weâre learning to ask: âWhatâs the least risky way to help?â 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 isnât to eliminate all medications. Itâs to make sure every pill you take is truly necessary, safe, and right for your body - not just your diagnosis.Is the Beers Criteria only for people in nursing homes?
No. The Beers Criteria applies to all adults 65 and older, whether they live at home, in assisted living, or in a nursing facility. It was originally created for nursing homes in the 1990s, but today itâs used in outpatient clinics, hospitals, and pharmacies across the U.S. because older adults face the same risks regardless of where they live.
Can I still take a drug on the Beers Criteria list if my doctor says itâs okay?
Yes - but only if thereâs a clear, documented reason. The Beers Criteria isnât a ban. Itâs a warning. For example, a person with severe dementia-related aggression might need an antipsychotic if other treatments have failed and theyâre a danger to themselves. In those cases, the doctor should explain why the risk is justified and monitor closely. Never assume a flagged drug is automatically unsafe - but always ask why itâs being prescribed.
Are over-the-counter drugs included in the Beers Criteria?
Yes. Many OTC drugs like diphenhydramine (Benadryl), dimenhydrinate (Dramamine), and even some sleep aids and allergy meds are on the list because they have strong anticholinergic effects. Seniors often donât realize these count as âmedicationsâ - but they can cause confusion, falls, and urinary retention just like prescription drugs.
How often is the Beers Criteria updated?
Every three years. The most recent version was published in May 2023, and the next update is expected in 2026. Each update adds new evidence - in 2023, over 7,300 studies were reviewed. The American Geriatrics Society also releases minor updates and the Alternatives List in between major releases.
Does Medicare require doctors to follow the Beers Criteria?
Medicare doesnât require doctors to follow it directly, but it does require pharmacy benefit managers to use the Beers Criteria in medication therapy management programs for beneficiaries taking eight or more prescriptions. Many EHR systems also have Beers Criteria alerts built in, so doctors see warnings when prescribing flagged drugs. While not legally mandatory, ignoring it can increase liability and affect quality ratings for providers.
What should I do if my doctor prescribes a Beers-listed drug?
Ask three questions: 1) Why is this the best choice for me? 2) Is there a safer alternative? 3) What are the risks if I take it vs. if I donât? If youâre unsure, ask for a pharmacist consultation - many clinics offer free medication reviews. Bring a list of all your meds, including supplements and OTC drugs. You have the right to understand every prescription youâre given.
Andy Louis-Charles
November 25, 2025 AT 13:44Been using this list for years as a geriatric pharmacist. Saw a 78yo patient stop diphenhydramine and sleep better without the next-day fog. No more falls. No more confusion. Just quiet nights. đ
Douglas cardoza
November 26, 2025 AT 07:01My grandma was on 12 meds before we went through Beers. Cut it down to 5. Sheâs walking better, talking clearer, and actually remembers our names now. Why isnât this mandatory for every seniorâs script?
Adam Hainsfurther
November 26, 2025 AT 09:09Itâs fascinating how a clinical tool born in nursing homes became the backbone of outpatient care. The cultural shift here is quiet but massive - from âmore pills = better careâ to âless is more when itâs safer.â The Alternatives List is the real win. Not just telling doctors what to avoid, but giving them a path forward.
Nikki C
November 26, 2025 AT 15:35They put Benadryl on the list and suddenly everyoneâs like oh wow but itâs been in every medicine cabinet since 1985
Alex Dubrovin
November 28, 2025 AT 02:44My dadâs on gabapentin for nerve pain. Dose was 300mg three times a day. Pharmacist flagged it. Cut it to 100mg once. He still feels better and no more dizziness. Beers saved his balance
Jacob McConaghy
November 28, 2025 AT 16:05Doctors get alert fatigue? Yeah I get it. But if youâre prescribing a Beers-listed drug without even reading the warning, youâre not a doctor - youâre a vending machine. The systemâs not broken, itâs just ignored. Time to stop letting convenience override safety.
Natashia Luu
November 30, 2025 AT 01:25It is deeply concerning that the medical establishment continues to prioritize pharmaceutical profit margins over the physiological integrity of elderly patients. The Beers Criteria is not merely a guideline - it is an ethical imperative that has been systematically undermined by corporate influence and clinical negligence.
akhilesh jha
December 1, 2025 AT 15:54Interesting. In India, many seniors take antihistamines for sleep because theyâre cheap and available without prescription. No one knows about Beers. We need this awareness here too. Maybe someone should translate it into Hindi?
Jeff Hicken
December 2, 2025 AT 16:36so like⌠benadryl is bad but melatonin is good? but melatonin is just a hormone and its not regulated so like⌠who even knows whatâs in those pills? i think the whole thing is a scam
Vineeta Puri
December 3, 2025 AT 08:42As a nurse educator in rural India, Iâve seen elderly patients suffer from polypharmacy due to lack of access to specialists. The Beers Criteria is a vital tool, but its true impact lies in education. We must train community health workers to recognize anticholinergic burden and advocate for safer alternatives - not just in the U.S., but globally. Knowledge is the first step toward dignity in aging.