Background: The American Geriatric Society (AGS) creates a consensus report, the Beers Criteria, of medications that may potentially inappropriate for older persons. The 2019 Beers Criteria consists of medications across many classifications and indications that could have potentially harmful effects on older patients, including contributing delirium, falls, hypotension, and urinary retention. Providing the highest quality of care to hospitalized patients requires individualized care plans that should consider a patients age and potential impact of Beers Criteria medications.
Methods: This retrospective cross-sectional analysis of all adult hospital admissions to a large, tertiary care, academic hospital looking at the frequency of receipt of Beers Criteria medications from August 1, 2018 to February 1, 2020. Admissions were divided by age, 18-64 and greater than 65 years old and compared using chi-square analysis for the receipt of any Beers Criteria medication and further analyzed to receipt of 0, 1, 2, 3 or more than 4 Beers Criteria medications. The 2019 AGS Beers Criteria medication list was used for this study.
Results: 34,083 admissions were included in the study. 60.4% (n=20,598) were age 18-64 and 39.6% (n=13,485) were age 65 or older. 91.2% (n=20,598) of patients 18-64 years old received a Beers Criteria medication, while 88.3% (n=13,485) of patients older than 65 years received a Beers Criteria medication. Further analysis of the percentage of patients aged 18-64 receiving 0, 1, 2, 3 and more than 4 revealed 8.8%, 13.0%, 14.8%, 13.7% and 49.74%, respectively. The percentage of patients older than 65 years receiving, 0, 1, 2, 3, and more than 4 were 11.7%, 18.3%, 17.4%, 13.7% and 38.9%, respectively.
Conclusions: The majority of hospitalized older adults receive at least one potentially inappropriate medication as described the AGS Beers Criteria. There is only a modest difference in the percentage of adults less than 65 and those older than 65 who receive one or more of these medications. These results suggest that there is great opportunity for more discretion when prescribing medications to older adults during their hospitalization. Further study looking at falls, delirium, length of stay and discharge disposition will be important in quantify the impact of these potentially inappropriate prescriptions.