BEERS Criteria and Fall Risk in the Older Adult

Nov 16

Essential Points:

The BEERS Criteria highlights potentially inappropriate medications (PIMs) for older adults, taking into account the physiological changes that occur with aging and how they affect drug metabolism, with a focus on medications that can increase fall risk.
Medications like Benzodiazepines, Anti-depressants, and Anti-psychotics are among those flagged for potentially causing balance disturbances and elevating fall risk in older adults, particularly when used in combination with other CNS-active drugs.
Polypharmacy and drug interactions are key considerations when managing older adults' medications, as changes in drug regimens can significantly impact balance and safety; healthcare providers should be vigilant and refer patients to specialists when necessary.

As healthcare professionals, I think we can all agree pharmacology is rough. When I was in grad school it was the bane of my existence. I just could never get the crazy names and drug categories to stick in my brain. I have so much respect for Pharmacists after that experience. You all are a different breed of human in every way. Even though pharmacology is difficult for the rest of us, that does not mean we should simply breeze over the importance of the medications that our patients are taking.

Correct me if I am wrong, but I would guess that a large subset of physical therapists, and other ancillary healthcare providers, often assume that the medications a patient is taking are on the up-and-up. Ninety percent of the time I would agree; it is the other ten percent I am concerned about. Physicians and Pharmacists are human and therefore fallible. Sometimes medications are given with the best intent, but then make a problem worse or create a different problem entirely. This is where the BEERS Criteria comes in.

Intro to the BEERS Criteria

The BEERS Criteria was created and developed in 1991 by Mark Beers, MD. He recognized that as we age our physiological functions tend to decline or change. Consequently, the way our body interacts and metabolizes medications changes. A drug that may work perfectly for a thirty-year-old patient, may have disastrous consequences for the eighty-year-old patient with a similar pathology. The BEERS Criteria takes these physiological changes into account and provides a list of Potentially Inappropriate Medications (PIMs) for the older adult. Although many of the medications on the BEERS Criteria list work as they are intended, the heart of the criteria is that these medications may do more harm than good. It is important to note that this list was never intended to override clinical judgement, but rather bolster and fortify appropriate care in an area that was lacking within healthcare. Overall, it is a resource to detect a red flag in the realm of drug therapy for those 65 and over.

Although the BEERS Criteria references many potential side effects of medications, for our purposes I am only focused on the ones that can cause balance disturbances of various origins and increase fall risk. These medications may include Benzodiazepines, Nonbenzodiazepine benzodiazepine receptor agonist hypnotics, Anti-depressants, Anti-epileptics, and Anti-psychotics, among others. It is also important to note that some of these drugs are safe on their own, but may cause issues when used in combination. This is common when multiple CNS-active drugs are used together. Whenever poly-pharmacy is in play, it is important to check for negative drug interactions, especially if a medication prescription coincides with onset of new symptoms or ADL disturbances. If a drug is suspected of causing increased safety risk to a patient, it is our job to refer out to the appropriate medical provider. Sometimes, a simple change in medication may resolve a large part of a patient’s balance deficits and fall risk.