Geriatrics and pharmacology: A new guide to Beer Criteria alternatives

Knowing how to avoid an inappropriate medication for your elderly patients is good. But quickly identifying how to replace it, especially with non-pharmacological options, is even better. The start of the school year is the perfect time to update your clinical habits—and the American Geriatrics Society (AGS) recently offered a valuable tool in to aid deprescribing efforts.Published at the end of July by the AGS, the new resource offers a much-needed update (the last one in 2015) of concrete alternatives—pharmacological or not—based on evidence and aimed at replacing potentially inappropriate medications for elderly patients."It's a really good tool for all physicians, not just geriatricians," says Dr. Carolane Rioux, a member of the board of directors of the Association des médecins gériatres du Québec (AMGQ). "It should be distributed to all physicians who work with the elderly." According to Dr. Rioux, who is also an internist-geriatrician at Hôpital Notre-Dame in Montreal, the new Guide to Alternative Treatments to Certain Medications Selected According to the Beers 2023 Criteria can benefit all primary care providers. "We focused on the cases where clinicians are most likely to encounter difficulties with the Beers criteria [and] on the drugs for which it seemed most appropriate to propose alternatives," said Todd P. Semla, co-chair of the committee and author of the scientific article, in a press release. The result is a simple clinical resource organized by clinical conditions, which offers solutions "that are often safer and at least as, if not more, effective than the drugs they replace." For example, for anxiety symptoms, the Beers criteria recommend avoiding all benzodiazepines, first-generation antihistamines, tricyclic antidepressants and barbiturates. The alternative treatment guide instead suggests a graded approach: investigation of causes, prioritization of psychotherapy and selective use of agents such as escitalopram, sertraline or venlafaxine when medication is unavoidable.Deprescribing: Where to start?“We really have a comprehensive, patient-centred approach,” explains Dr. Rioux. “We review their entire medication, we reconsider each pill, one by one [to] assess the interaction and the side effect profile.”Polypharmacy is a reality closely linked to geriatrics, a field where deprescribing has long been in the air. “But for physicians who are perhaps less qualified to review polypharmacy, the guide is a very good tool for making an initial deprescription,” says the internist-geriatrician. “What do I stop? Why? What can I do instead?”More on deprescribing: Can tools fix our polypharmacy problems?"Nurses in general, those specializing in geriatrics, those in home care, consultants—these are principles that need to be known and taught to them," adds Didier Mailhot-Bisson, professor of geriatrics at the School of Nursing and researcher at the University of Sherbrooke's Research Center on Aging. "The guide is a tool that significantly supports the nurse's clinical judgment." Through their role, nurses are often the first to check a patient's medication and flag potentially inappropriate cases. Professor Mailhot-Bisson also discusses the work of NPs who can prescribe medication: "For pain, for example, before resorting to control medications or narcotics, can we use physiotherapy? Passive-active exercises? The guide even suggests using mindfulness meditation."Convincing a patient to ditch pills in favour of alternative treatments can be a challenge in itself. As such, the AGS publication contains links to resources specifically dedicated to older adults. “It's definitely more patient education, more outreach,” acknowledges Mailhot-Bisson. “Monitoring medication is a challenge. Monitoring alternative methods is something that needs to be put in place. And sometimes, you also need an interdisciplinary team. . . . Ultimately, it's a collaborative effort between geriatricians, doctors, nurses and other professionals.”More on deprescribing: Where to start?"This entire approach is done with the goal of improving the patient's quality of life," concludes Dr. Rioux. "It's done according to their life prognosis, their functional prognosis. It's really adapted to each individual. . . . It's a collaborative process, and the patient is involved in these decisions." The alternative treatment guide is available online in the Journal of the American Geriatrics Society and will soon be integrated into the AGS Beers Criteria mobile app.This article has been translated from its original French and originally appeared in our sister publication, Profession Santé.

Geriatrics and pharmacology: A new guide to Beer Criteria alternatives

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