Question 1

Are the Beers Criteria applicable outside the United States?

Accepted Answer

Yes — although developed by the AGS, the Beers Criteria are used internationally. However, local formularies, availability of alternatives, and practice patterns may differ. Some countries have developed their own explicit criteria (e.g., STOPP/START in Europe, EU(7)-PIM list). Using multiple criteria in parallel may improve detection rate of potentially inappropriate medications.

Question 2

Does the Beers Criteria apply to all older adults equally?

Accepted Answer

No — the criteria are a guide, not a substitute for clinical judgement. Some listed medications may be appropriate in specific clinical contexts (e.g., benzodiazepines for rapid eye movement sleep behaviour disorder, or NSAIDs for acute gout). The criteria should be applied as part of a thorough medication review, considering patient preferences, goals of care, and life expectancy.

Question 3

How does Beers differ from STOPP/START criteria?

Accepted Answer

Beers is primarily a list of medications to avoid (explicit, US-based). STOPP/START is a European tool that includes both potentially inappropriate medications (STOPP) and potential prescribing omissions (START, e.g., missing bisphosphonates or statins in indicated patients). Using both tools together provides more comprehensive medication review.

Question 4

What is the evidence that using Beers improves outcomes?

Accepted Answer

Cohort studies show that exposure to Beers-listed medications is associated with increased risk of adverse drug events, falls, hospitalisation, and mortality. However, randomised trials of implementing Beers-based deprescribing have shown mixed results on hard outcomes. The benefit likely depends on the clinical context and the specific medications deprescribed.