"The Beers List" - Medication Criteria Screening Tool for the "Elderly" (over 65)

The first "Baby Boomer" turned 65 in 2011! With 15% of the population being 65 or over and the BIG group of Boomers coming down the turnpike, many of the people in the Lumigrate 'audience' have concerns related to medications and driving, driving with medical impairment and aging, adaptive equipment and strategies to keep them safer and as independent as possible.  But that 15% is taking OVER 33% of the prescription and over-the-counter (OTC) medications in the US! 

I became an OTR in 1997 after graduating at the very end of 1996.  I learned of the Beers list after moving to Grand Junction and being at a small skilled nursing facility as the primary occupational therapist and having access to learning from their pharmacy consultant; that was in 2004.  So I worked many years with people over the age of 65 in many environments -- driving rehabilitation, skilled nursing, hospitals, without the benefit of knowing of this list! I guess since occupational therapists don't have prescribing authority, we were left out of the loop.  

Occupational therapists are specialists in FUNCTION, and when a person has a problem functioning in their 'occupations' (what occupies their time), we then are asked to be part of figuring it out, and then solving the problems.  I found the Beers to be among the top tools I had to draw upon to help me figure things out.  As part of our evaluations, we collect a full medical history and that includes what medications are being taken.  As physicians and their assistants who prescribe medications and give out that type of advice get more and more 'strained and drained', the other members of the team helping a person with their health care became more critical than ever.  

Many times I found something in the medical charts of patients and brought it to their attention and it was very helpful; that's actually probably my biggest 'forte' or strength.  I inherited and was brought up in an environment that was very heavily logical.  About a year ago, Dr Young was called by a patient's court-appointed team leader for an evaluation and he deflected them to me since I'm cheaper, and I was able to effectively get things teased apart and found there was something unusual that everyone ran with for many years and it just seemed suspicious to me and worth having them backtrack and get the actual records when the diagnosis was supposedly made.  

It took a full year to get the patient 'undiagnosed" and off the medications that were unnecessary.  Then they called me and said 'he doesn't see why he should still have the court-appointed people and he wants to take over these responsibilities again" -- but we were only half there! There needed to be a proper diagnosis, and just because one specialist says "unknown" does NOT mean "there's nothing going on", so it required them come back around again to meet with Dr Young.  Again, saving much money for the patient/client. 

So I provide this tool for you here, since today the reality is that people increasingly need to do as much of this on their own for their family or friends/loved ones with less assistance from professionals with experience like I have.  I recommend people ask others to help them with this type of task: "two heads are better than one", typically.  (Naturally, that can NOT be the case of someone is really incapable, I've experienced that as well.  Not just in this type of situation / work but when I offered to help a band with backups when their backup singer was not very good.  But they didn't want to offend her as it was a student organization and she had a position with the organization, so I had to sing next to her and they turned her microphone off so nobody else could hear her.  But I could! I wasn't nearly as able to harmonize and hear what the singer was doing with someone badly singing right next to me.  Again, I'm always trying to bring a little humor and distraction to the hard realities of the information here.... hope you appreciate it! 

Back to the Beers List -- and I presume someone by the last name of Beers created it -- and why it's so important.  As the body ages, there are physiologic changes that occur which affects how medications are processed and therefore affect the person.  Where I noticed this most, due to the elderly sleeping less by nature and then feeling tired and their doctors providing medications for sleep.  Naturally, many of the patients had a history of falling and I would look closely at what medications the person took.  Sometimes it was something that they'd been on 'forever' and as they got older nobody though 'wait, is this something prudent to be taking at this age?'  Other things top conditions/diagnoses the elderly are  prescribed medications for are: depression, constipation, urinary problems (going too often, the body not making enough urine/retention, incontinence), decreased appetite.   "ADE" stands for "adverse drug events", and along with falls and injuries, ADEs are causing an estimated 30% of hospitalizations. 

Medications are often metabolized by the liver and as age increases, the liver decreases in mass and the blood flow can slow the rate of elimination by the liver. Overall, there is a decrease of 30-40% in the elderly in this 'clearance' by the liver/'hepatic' system. 

The kidney also ages, naturally -- and the size and blood flow of the kidney decreases significantly with age.  "Renal" being the word for this system in the body.  When labs are run on the blood / 'serum' to check creatinine (a measure of the renal system's effectiveness), the numbers may show as 'normal' or WNL (within normal limits) because the lowered body mass of the body produces less creatinine.  The practitioner then won't realize that an adjustment in the dosage of a medication is prudent.  However, these changes decrease the clearance of drugs in the renal system that requires adapting the dose of the medication.  Simply knowing this as a medical consumer might allow people to inquire when the prescription is being 'written', reminding a provider of these concepts.  Again, they're inundated sometimes with things to process mentally and there's a variety of tolerance for getting overwhelmed and this will affect what the provider 'provides', quite simply.