Advanced pharmacology education is not only about learning new drug therapies. For APRNs, it also means refining clinical judgment around medication safety, particularly in high-risk populations.
Older adults are especially vulnerable to adverse drug events due to age-related physiologic changes, polypharmacy, and increased sensitivity to specific medication classes. This is why the American Geriatrics Society (AGS) Beers Criteria remains a widely used tool for identifying potentially inappropriate medications in the care of older adults.
What Is the Beers Criteria?
The Beers Criteria, maintained by the American Geriatrics Society, is a list of medications considered potentially inappropriate for older adults. The purpose is not to eliminate these medications outright, but to promote safer prescribing and reduce exposure to higher-risk agents.
The criteria are updated regularly, with the most recent update published in 2023.
A key reminder emphasized throughout Dr. O’Brien’s program is that Beers is intended to support clinical decision-making, not replace it.
Why Beers Medications Still Appear in Practice
Potentially inappropriate medications remain common in older adult care settings. Dr. O’Brien notes that many Beers medications are prescribed due to habit, patient expectations, or clinical uncertainty.
These medications are associated with increased risks of adverse outcomes, including:
- Falls
- Delirium
- Cognitive decline
- Hospitalizations
These risks make prescribing for geriatric patients a critical area of focus for APRNs pursuing advanced pharmacology continuing education.
Common Beers Offenders and Substitution Thinking
APRNs often encounter high-risk medications across multiple drug classes. The presentation highlights several examples frequently seen in practice:
- Diphenhydramine, due to anticholinergic risk
- Diazepam, due to sedation and delirium potential
- Glyburide, due to hypoglycemia risk
- NSAIDs, due to gastrointestinal and kidney concerns
The program emphasizes substitution thinking, such as considering melatonin or cognitive behavioral therapy for insomnia, SSRIs or buspirone instead of certain benzodiazepines, or alternative diabetes agents when appropriate.
This approach reflects an advanced pharmacology competency: understanding not only which medications are high risk, but why, and what safer options may exist.
Case-Based Judgment: When the Answer Is Not Automatic
One clinical case presented involves an 80-year-old with osteoarthritis, insomnia, and mild cognitive decline who is taking amitriptyline to manage chronic neuropathic pain and improve sleep quality, without benefit.
APRNs are challenged to evaluate risks and consider:
- Anticholinergic effects
- Sedation and fall risk
- Cognitive burden
- Patient counseling and deprescribing strategies
This type of real-world evaluation is central to pharmacology-focused care in older adults.
Beers Is a Guideline, not a Mandate
One of the most important takeaways from Dr. O’Brien’s session is that the Beers Criteria should be used as a guideline, not a list of prohibited drugs.
There may be circumstances where benefits outweigh risks, especially when quality of life, dementia care, or end-of-life goals are involved. Ethical prescribing requires individualized decision-making, not blanket avoidance.
Strategies for Safer Prescribing
Dr. O’Brien outlines practical strategies APRNs can apply immediately, including:
- Medication reconciliation
- Using Beers as a prescribing flag, not a ban
- Collaboration with pharmacists
- Deprescribing when appropriate
- Considering tools such as deprescribing.org and clinical decision support resources
Explore Pharmacology CE for APRNs
Prescribing in older adults often involves balancing benefit, risk, and patient-specific goals of care. As emphasized in this article, the Beers Criteria is a guideline, not a mandate, and APRNs must apply pharmacologic knowledge with individualized clinical judgment when prescribing for older adults.
For APRNs seeking structured continuing education in advanced pharmacology topics such as high-risk medication use, deprescribing, and medication safety in older adults, the freeCE APRN Pharmacology CE Membership offers access to pharmacology-focused CE activities designed to support certification renewal planning.
As with all CE, APRNs should review individual course details to confirm pharmacology designation and applicability to ANCC or AANP renewal requirements.
Using the Beers Criteria
Advanced practice includes knowing when a medication may cause harm, when it may still be justified, and how to personalize therapy safely in older adults.
By using the Beers Criteria as a clinical tool rather than a rigid rule, APRNs can improve medication safety, support geriatric outcomes, and strengthen confidence in high-stakes prescribing decisions.
In a recent PharmCon freeCE educational activity, Carolyn O’Brien, PhD, AGPCNP-BC, reviewed how APRNs can apply the Beers Criteria thoughtfully and ethically in real-world prescribing decisions.
APRNs seeking comprehensive pharmacology continuing education can explore the freeCE APRN Pharmacology CE. Our courses make complex medical concepts engaging and easy to understand, regardless of your current experience level. Dive into the latest pharmacology trends and developments through straightforward, interactive instruction and on-demand CE activities designed to support advanced clinical practice.
Sources
Carolyn O’Brien, PhD, AGPCNP-BC. Think Before Acting: Justifying the Use of BEERS List Medications in Older Adults. PharmCon freeCE Educational Activity.
American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society. 2023;71(4):1163–1181.
Reeve E, Shakib S, Hendrix I, Roberts MS, Wiese MD. Balancing benefit and harm when deprescribing: A systematic review and development of a patient-centered deprescribing framework. BMJ Open. 2020;10(5):e032494. https://doi.org/10.1136/bmjopen-2019-032494
Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. New England Journal of Medicine. 2022;386:327–336. https://doi.org/10.1056/NEJMsa2112353
O’Mahony D. Improving prescribing and patient safety in older adults: The role of potentially inappropriate medication lists and implicit criteria. Therapeutic Advances in Drug Safety. 2020;11:2042098620938248. https://doi.org/10.1177/2042098620938248
Peterson SJ, Eliason K. Nurse practitioner role in deprescribing for older adults. Journal for Nurse Practitioners. 2021;17(4):430–434. https://doi.org/10.1016/j.nurpra.2020.12.014
