1. In the clinical setting, ask students to review assigned client’s medication and be alert to any medications on the 2019 American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. As students review medications, have them consider the following:
- Is the medication on the list of Beers Criteria?
- What is the recommendation on the Beers Criteria regarding use of this medication?
- What are the potential problems associated with this medication for older adults as noted on the Beers Criteria?
- Is there a rationale for using the medication on the Beers Criteria? (Is it being used routinely or on an as-needed basis?)
- How would you articulate your concern about this medication being used by your older adult client to the interprofessional team of caregivers?
The following chart can be used by students as a reference to organize a client’s medications according to the Beers Criteria:
| Medication | Is medication on the Beers Criteria? Yes/No | If medication is on the Beers Criteria, Avoid/ Avoid with Certain Parameters? | What is the rationale for being concerned about use of this medication by older adults? | How would you communicate your concerns regarding this medication to the health care team? |
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2. The sample medication lists below can be used in conjunction with any of the ACE.S or ACE.Z unfolding cases or as part of teacher-crafted case studies. The lists include medications on the Beers Criteria. As students review and assess these medications, have them consider the following:
- Is the medication on the Beers Criteria?
- What is the recommendation on the Beers Criteria regarding use of this medication?
- What are the potential problems associated with this medication for older adults as noted on the Beers Criteria?
- Is there a rationale for using the medication on the Beers Criteria? (Is it being used routinely or on an as-needed basis?)
- How would you articulate your concern about this medication being used by your older adult client to the interprofessional team of caregivers?
The following chart is used as reference for students to organize the medications on the list in relation to the Beers Criteria
| Medication | Is medication on the Beers Criteria? Yes/No | If the medication is on the Beers Criteria, Avoid/Avoid with Certain Parameters? | What is the rationale for being concerned about use of this medication by older adults? | How would you communicate your concerns regarding this medication to the health care team? |
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Patient with diagnosis of hypertension, hypothyroidism, neurocognitive impairment, degenerative joint disease, and gastrointestinal ulcer (3 years ago):
| Doxazosin extended release 4 mg daily | Risperidone 0.25 mg 1 pm & 9 pm |
| Lisinopril 10 mg daily | Levothyroxine 225 mcg 6 am daily |
| Donepezil 10 mg at 9 pm | Ibuprofen 600 mg prn x2 daily for pain |
Patient with Parkinson’s disease, hyperlipidemia, urinary incontinence, osteoporosis, and sleep disturbance:
| Carbidopa-Levodopa 25/100 8 am, 2 pm, & 8 pm daily | Diphenhydramine 25 mg hs |
| Simvastatin 10 mg at 9 am | Pimavanserin 34 mg at 9 am |
| Alendronate sodium 10 mg daily | Tolterodine LA 30 mg at 9 am |
| Melatonin 3 mg at hs | Lorazepam 1 mg prn for dental visits |
Patient with diabetes mellitus type 2, diabetic neuropathy, constipation, anxiety, congestive heart failure, gait dysfunction:
| Amiodarone 400 mg daily | Senna 8.6 mg daily |
| Metformin 750 mg daily | Escitalopram 20 mg at 9 am |
| Nortriptyline 75mg q hs | Alprazolam q 6 hours prn for anxiety |