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April 18, 2019
2019 Beers Criteria Update: The American Geriatrics Society (AGS) produces and regularly updates the Beers Criteria, a list of medications that are potentially inappropriate for use in adults aged 65 years and older. A 13-member interprofessional panel systematically assessed the evidence since the last update in 2015 and published the latest update in January 2019. The new AGS Beers Criteria® includes 30 medications/medication classes that are potentially inappropriate in older adults. The criteria also contains 40 medications/medication classes that should be avoided in older people with certain conditions or to be used with caution. Twenty-five medications/medication classes were removed from the AGS Beers Criteria® in the 2019 update. The AGS Beers Criteria® is a tool for safe medication management in older adults.
Upon completion of the chapter, the reader will be able to:
Explain changing aging population demographics.
Discuss age-related pharmacokinetic and pharmacodynamic changes.
Identify drug-related problems and associated morbidities commonly experienced by older adults.
Describe major components of geriatric assessment.
Recognize interprofessional patient care functions in various geriatric practice settings.
The growth of the aging population and increasing lifespan require that health care professionals gain knowledge necessary to meeting the needs of this patient group. Despite the availability and benefit of numerous pharmacotherapies to treat their diseases, older patients commonly experience drug-related problems, resulting in additional morbidities. Therefore, it is essential for clinicians serving older adults across all health care settings to understand the epidemiology of aging, age-related physiological changes, drug-related problems prevalent in the elderly, comprehensive geriatric assessment, and interprofessional approaches to geriatric care.
EPIDEMIOLOGY AND ETIOLOGY
As humans age, they are at increasing risk of disease, disability, and death for three reasons: (a) genetic predisposition; (b) reduced immunological surveillance; and (c) the accumulated effects of physical, social, environmental, and behavioral exposures over the life course. Elders experience variably increasing vulnerability (homeostenosis) as they age, resulting in heterogeneity in health states and care requirements. While resilient elders can maintain high levels of physical and cognitive functioning, others suffer functional decline, frailty, disability, or premature death. There is an urgent need for all clinicians to better understand the epidemiology of aging in order to comprehensively provide high value services to optimize the function and health-related quality of life of older adults.1
Our population is rapidly growing older. In 2015, 47.8 million US residents were 65 years and older (nearly 15% of the total population), with projections to more than double to 98 million by 2060.2 Almost 6.3 million people were 85 years or older (the “oldest-old”), and ...