Developing explicit positive beers criteria for preferred central nervous system medications in older adults

Background: The Beers criteria have been extensively used over the past decade to identify and evaluate potentially inappropriate medication use in adults 65 years of age and older in the United States. In contrast to the Beers criteria, the purpose of this pilot initiative was to develop a new set of explicit criteria for determining preferred (rather then potentially inappropriate) medications to use in older adults, using similar methodology as used in the three iterations of the Beers criteria. This initiative organized its evaluations around classes of medications that are both frequently used and associated with drug-related problems in older adults-central nervous system (CNS) medications. Methods: This pilot study used a modified Delphi method - a set of procedures and methods for reaching group consensus for a subject matter in which precise information is lacking - to determine medications that are preferred for use in persons 65 years of age or older known to have specific medical conditions. Medications were selected as preferred because they are both effective, based upon a thorough evaluation of the clinical evidence, and pose less risk for older persons compared with alternative medications for the condition. Expert panelists evaluated 78 individual medications within four medical conditions (dementia, depression, Parkinson's disease, and psychosis). Results: This study identified 13 preferred medications to be used in older adults with these conditions. Conclusions: This study expands explicit criteria to more precisely define preferred medication use in older adults. This refinement of the Beers criteria will enable providers to select medications with the greatest benefit-to-risk ratio for older adults, thereby minimizing drug-related problems. These criteria will need to be expanded to include other medication classes and medical conditions frequently encountered in older adults.