Beers Criteria Medications: What Caregivers Need to Know About the 2023 AGS List

If your parent is over 65 and taking multiple medications, there's a decent chance at least one of them is on a list doctors are explicitly told to avoid in older adults. That list is the American Geriatrics Society Beers Criteria — updated in 2023 — and it's the single most useful document a caregiver can bring to a medication review.

What the Beers Criteria Is

The Beers Criteria was first published in 1991 by Dr. Mark Beers and is now maintained by the American Geriatrics Society (the 2023 update is the current version). It catalogs close to 100 medications and drug classes that are potentially inappropriate for adults 65 and older, organized into five categories:

1. Medications to avoid in most older adults
2. Medications to avoid with specific diseases or syndromes (e.g., drugs that worsen dementia or glaucoma)
3. Medications to use with caution — not banned, but need a clear reason and monitoring
4. Drug-drug interactions to avoid
5. Medications requiring kidney-function dose adjustments — critical because aging kidneys clear drugs more slowly

"Potentially inappropriate" doesn't mean automatically dangerous for every person. It means the risks usually outweigh the benefits in older adults, so the prescriber should have a specific, documented reason for using it.

The High-Risk Medications Caregivers See Most Often

A few Beers-listed drugs show up constantly in real-world senior regimens:

• Diphenhydramine (Benadryl) and other anticholinergics. Found in OTC sleep aids and allergy pills. These carry cumulative "anticholinergic burden" — linked to falls, delirium, urinary retention, and long-term dementia risk. This is the most common hidden problem because nobody thinks of OTC products as real medications.
• Benzodiazepines (lorazepam, alprazolam, diazepam). Prescribed for anxiety or sleep, they cause sedation and balance impairment. The European STOPP criteria flag use beyond four weeks outright.
• NSAIDs (ibuprofen, naproxen) used long-term. In older adults these can trigger acute kidney injury, raise blood pressure, and cause gastrointestinal bleeding — risks that climb steeply with age.
• Tricyclic antidepressants (amitriptyline and relatives). Strongly anticholinergic; can worsen cognition, and are specifically dangerous with dementia or glaucoma.
• Long-term proton pump inhibitors (omeprazole and relatives). Started for short-term reflux and never stopped; long-term use is linked to fractures, kidney disease, and C. difficile infection.
• Sulfonylureas and sliding-scale insulin. In seniors, low blood sugar episodes are more dangerous than mildly high numbers; falls from hypoglycemia break hips.

The International Version: STOPP/START

If your parent is in the UK, Ireland, or Europe, clinicians use the STOPP/START criteria (Version 3, 2023) instead of Beers — 190 criteria covering inappropriate prescriptions (STOPP) plus medications that should be started but were overlooked (START), like anticoagulation for atrial fibrillation. The framework differs but the caregiver takeaway is identical: the full regimen needs periodic expert review, not just the newest prescription.

What to Do If a Medication on the List Shows Up

Three rules:

1. Never stop a medication abruptly on your own. Benzodiazepines, antidepressants, beta-blockers, and PPIs can cause genuine harm if stopped cold. Deprescribing means a planned, gradual taper supervised by the prescriber.
2. Document it. Add a flag on your parent's master medication list: "On Beers list — ask about alternatives."
3. Ask for a formal medication review. In the US, Medicare Part D's Medication Therapy Management program offers a free annual Comprehensive Medication Review for beneficiaries on 8+ maintenance medications with 3+ chronic conditions. In Australia, a GP referral gets a free Home Medicines Review, which resolves up to 85% of identified drug-related problems. The UK offers NHS Structured Medication Reviews, and Canadian pharmacists do meds-checks.

A good script for the doctor: "We went through the AGS Beers Criteria and noticed [medication] is listed as potentially inappropriate for someone Mom's age. Is there a specific reason it's the right choice for her, or is there a safer alternative we could trial?"

The Bigger Picture

The Beers Criteria is a screening tool, not a verdict — but it's the fastest way to spot the medications most likely to be causing a parent's dizziness, confusion, or falls. Combine it with a complete master medication list (including OTC products and supplements, where anticholinergics hide) and an annual professional review, and you've covered the highest-yield medication safety step there is. The Managing a Parent's Medications Safely toolkit includes the review-request scripts and medication list templates to make that conversation easy.