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Geriatrics > Ger 7 Beers Criteria > Flashcards

Ger 7 Beers Criteria Flashcards

1
Q

What are the 4 intentions of the Beers Criteria?

A
  1. Improve the selection of prescription drugs by clinicians and patients
  2. Evaluate patterns of drug use within populations
  3. Educating clinicians and patients on proper drug usage
  4. Evaluating health-outcome, quality of care, cost, and utilization data
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2
Q

What will help achieve the goal of evaluating and managing drug use in older adults while considering the dynamic complexities of the healthcare system?

A

Regular updates to the Beers Critera

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3
Q

What supersedes the Beers Criteria list?

A
  1. Clinical judgement

2. Individual patients values and needs

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4
Q

What are 2 elements of prescribing and managing disease conditions?

A
  1. Individualization

2. Shared decision making

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5
Q

What are 2 examples where a heath care provider determines that a drug on the list is the only reasonable alternative?

A
  1. End of life

2. Palliative care

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6
Q

What else can the Beers Criteria be used for besides prescribing medications?

A

Monitoring their effects in older adults

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7
Q

If you choose a drug on the list for an elderly patient, what do you need to do?

A

Close monitoring for Adverse Drug Effects

*This can be incorporated into the electronic heath record and prevented or detected early

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8
Q

What is something else that the Beer Criteria emphasizes the importance of?

A

Nonpharmacological methods of treatment

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9
Q

What are 3 things thoughtful application of the Beers Criteria will allow for?

A
  1. Closer monitoring of drug use
  2. Application of real-time e-prescribing and interventions to decrease ADEs in older adults
  3. Better patient outcome
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10
Q

What is a PIM?

A

Potentially inappropriate medications

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11
Q

What is a systematic review and grading of the evidence on drug-related problems and ADEs in older adults?

A

Beers Criteria

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12
Q

What was used to update the 2012 AGS Beers Critera?

A

A modified delphi method (EVIDENCE-BASED APPROACH)

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13
Q

Who developed the Beers Criteria?

A

American Geriatrics Society (AGS) and an interdisciplinary panel of 11 experts in geriatric care/pharmacotherapy

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14
Q

What are the 3 catergories that medications or medication classes encompassing the update Beers Criteria were placed into?

A
  1. PIM and classes to avoid in older adults
  2. PIM and classes to avoid in older adults with certain diseases and syndromes
  3. Medications to be used with caution in older adults
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15
Q

How many medications or medication classes encompassed the update Beers Criteria?

A

53

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16
Q

What % of ADEs in primary care were preventable according to estimates from past studies in ambulatory and long-term care settings?

A

27%

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17
Q

What % of ADEs in long-term care were preventable according to estimates from past studies in ambulatory and long-term care settings?

A

42%

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18
Q

Where do most problems occur with regards to care?

A

At the ordering/monitorying stages

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19
Q

In the 2000/2001 medical expenditure panel survey, what was the total estimated healthcare expenditures related to the use of PIMs?

A

7.2 billion

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20
Q

What can explicit criteria do?

A

Identify high-risk drugs using a list of PIMs (by looking at Beers Criteria list

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21
Q

When was the first Beers criteria (list of PIMs) for nursing home residents published?

A

1991

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22
Q

What does the revised Beers List of PIMs created in 1997 and 2003 include?

A

All settings of geriatric care

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23
Q

What factors does implicit criteria include (2)?

A
  1. Therapeutic duplication

2. Drug-drug interactions

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24
Q

What has a strong link with poor patient outcomes like ADEs, hospitalization, and mortality in observational studies?

A

PIMs

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25
Q

True or False: PIMs have limited effectiveness in older adults

A

TRUE

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26
Q

What are PIMs associated with in older adults?

A
  1. Delirium
  2. GI Bleeding
  3. Falls
  4. Fracture
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27
Q

What is the best approach to improve health outcomes in older adults?

A

LESS IS MORE

*Safer non-pharmacological therapy substituted for use of medications

28
Q

What happens despite the preponderance of information regarding the prevalence of PIM usage (which has been examined in more than 500 studies since early 1990s)?

A

PIMs are still prescribed and use as 1st line treatment for the most vulnerable of older adults

29
Q

What regulations are PIMs now an integral part of policy and practice in?

A

Centers for Medicare and Medicaid Services (CMS) regulations

used in Medicare Part D

30
Q

What is crucial for the continued use of the Beers criteria as decision-making tools?

A

Being able to update them quickly and transparently

31
Q

What will regular updates improve in the Beers Critera (4)?

A
  1. Relevancy
  2. Dissemination
  3. Usefullness in clinical practice
32
Q

What is the intention of use for the 2012 AGS Beers Criteria?

A

Use in all ambulatory and institutional settings of care for populations aged 65+ in US

33
Q

Who is the primary target audience for the Beers Criteria?

A

Practicing clinician

34
Q

What is the specific goal of the 2012 AGS Beers Criteria?

A

Improve the care of older adults by reducing their exposure to PIMs

35
Q

Who developed the Beers Criteria?

A

An 11 member interdisciplinary expert panel

36
Q

What are the 3 framework principles guided by the Institute of Medicine used in the development of the Beers Criteria?

A
  1. Literature search
  2. Panel selection
  3. Development process
37
Q

What did members of the panel that developed the Beers criteria have expertise in? (5)

A
  1. Geriatric medicine
  2. Nursing
  3. Pharmacy practice
  4. Research
  5. Quality measures
38
Q

What practice settings did the members of the panel that developed the Beers criteria practice in? (5)

A
  1. Long term care
  2. Ambulatory care
  3. Geriatric mental health
  4. Palliative care
  5. Hospice
39
Q

What scale was used by panel members to complete the survey that helped develop the Beers Criteria?

A

5- Point Likert scale

Goes from strongly agree to strongly disagree

40
Q

How did the panelists individually rate the quality of evidence and strength of recommendation for each criterion?

A

Used the American College of Physicians Guideline Grading System
(This is based on the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) scheme)

41
Q

How were the panelists split to develop the Beers Criteria?

A

Into 4 groups, with each assigned a specific set of criteria for evaluation

42
Q

What is the date range for the literature search articles used?

A

December 1, 2001- March 30, 2011

43
Q

How many unduplicated citations for the full panel review were used?

A

2,169

44
Q

How many were systematic review or meta-analyses?

A

446

45
Q

How many were randomized controlled trials?

A

629

46
Q

How many were observational studies?

A

1.094

47
Q

How many citations were selected for the final evidence tables to support the list of drugs to avoid?

A

258

48
Q

Again, how many meds of medication classes encompassed the final updated 2012 AGS Beers Criteria?

A

53

49
Q

Again, what were the 3 categories drugs were placed in according to the Beers Criteria?

A
  1. PIMs and classes to avoid in older adults
  2. PIMs and classes to avoid in older adults with certain disease and syndromes that the listed drugs can exacerbate
  3. Medications and classes categorized into a list of meds to be used with caution in older adults
50
Q

How many drugs were added to the PIMs and classes to avoid in older adults?

A

34

51
Q

What are some notable additions to the PIMs and classes to avoid in older adults? (3)

A
  1. Megestrol
  2. Glyburide
  3. Sliding-Scale Insulin
52
Q

What are 3 new inclusions for PIMs and classes to avoid in older adults with certain disease and syndromes that the listed drugs can exacerbate?

A
  1. Thiazolidinediones or Glitazones in patients with heart failure
  2. Acetylcholinesterase inhibitors in older patients with syncope
  3. Selective serotonin reuptake inhibitors with falls and fractures
53
Q

How many meds and classes were categorized into a list of meds to be used with caution in older adults?

A

14

54
Q

How many medications/classes were dropped from 2003-2012?

A

19

55
Q

What are 2 examples of meds that were dropped from the list?

A
  1. Propoxyphene taken off market

2. Ethacrynic acid, insufficient evidence

56
Q

What is an important and improved update of previously established criteria?

A

The 2012 AGS Beers Criteria

57
Q

Who uses the 2012 AGS Beers criteria and for what?

A

Healthcare providers, educators, policy makers as a QUALITY MEASURE

58
Q

How many older adults previously received one or more medications on the list (depending on the care setting)?

A

40%

59
Q

Why are drug-disease and drug-syndrome interactions particularly important in the care of older adults?

A

Because they often take multiple medications for multiple comorbidities

60
Q

Who are the largest consumers of medication?

A

Older adults

61
Q

True or False: Drug trials represent older adults

A

FALSE: Older adults are underrepresented in drug trials

62
Q

What is the intent of the updated 2012 AGS Beers Criteria?

A

Use as an educational tool and quality meaure to improve the care of older adults by reducing their exposure to PIMs

63
Q

What 2 things does the Beers List NOT address?

A
  1. PIMs that aren’t unique to aging

2. Needs of individuals receiving palliative and hospice care

64
Q

What is often more important than avoiding the use of PIMs in patients receiving palliative and hospice care?

A

Symptom control

65
Q

What strengthens the update of the Beers Criteria?

A

Use of EVIDENCE-BASED APPROACH via the Institute of Medicine standards

Geriatrics (15 decks)

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