Clinical meaning
Applying the AGS Beers Criteria to prescribing decisions requires the NP to integrate geriatric pharmacology principles with individualized clinical judgment. The Beers Criteria is organized into five key tables: (1) medications that are potentially inappropriate in most older adults, (2) medications potentially inappropriate in older adults with specific diseases or syndromes, (3) medications to be used with caution, (4) clinically important drug-drug interactions to avoid, and (5) medications requiring dose adjustment based on kidney function. The prescribing decision framework involves three steps. First, identify PIMs on the patient's medication list by cross-referencing with the current Beers Criteria. Second, evaluate risk-benefit for each flagged medication considering the patient's specific clinical context, goals of care, life expectancy, functional status, and available alternatives. Third, implement changes through deprescribing (tapering and discontinuation), dose reduction, or substitution with safer alternatives. Deprescribing is a systematic, patient-centered process of tapering or stopping medications that are no longer needed or whose harms outweigh benefits. Key deprescribing principles include: taper medications that can cause withdrawal (benzodiazepines, opioids, SSRIs, beta-blockers, corticosteroids); discontinue one medication at a time to attribute any...