The Beers Criteria — usually just called 'the Beers List' — is the geriatrics field's consensus on medications that carry extra risk for adults over sixty-five. This list may drive deprescribing conversations with your primary care provider or specialist. Most families have never heard of it, and the list can have an impact on prescription choices.
This guide walks through what the Beers List is, what it is not, the categories of medications it flags most often, and how to review your prescriptions at your next doctor visit. The goal is not to second-guess prescribers — it is to empower you to have informed conversations around care choices.
TL;DR: The Beers Criteria are maintained by the American Geriatrics Society and updated every three to four years (most recently in 2023). The list does not say 'never prescribe these.' It says 'these carry extra risk in older adults — make sure the benefit is worth the risk, and watch carefully if you do use them.' Bringing the list into a doctor visit calmly, paired with the printed master medication list, is the move that produces real conversations rather than defensive ones.
What to know about the Beers List
The American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults is the official name for a list of medications and medication classes that, in the consensus of a large expert panel, carry elevated risk for adults sixty-five and older. These risks include falls, confusion, kidney injury, bleeding, or interactions that hit harder in older bodies. The list is updated every three to four years.
The list is structured in five buckets: medications to avoid in most older adults; medications to use with caution; medications to avoid in older adults with specific conditions (heart failure, dementia, kidney disease, etc.); medications that interact with each other in ways that matter especially in older adults; and medications that need dose adjustments based on kidney function. Most clinicians who work with older adults — geriatricians, geriatric pharmacists, hospitalists — are familiar with the list.
What the Beers List is not
The list is not a ban. It is not labeling medications as ‘bad’. Many medications on the Beers List are the right choice for the right patient — sometimes the only choice — and a thoughtful prescriber will use them carefully. The list is a flag that says: be deliberate, monitor closely, document the reasoning, and check whether something safer might do the job.
The list is also not a substitute for clinical judgment. The Beers Criteria are general; patients have specific needs and unique situations. A medication that is risky in most older adults may be exactly right for a patient given the rest of the medical picture. The Criteria themselves say so directly. The right framing for a family is not 'this drug should never be used' but 'this drug deserves a careful conversation.'
Categories the list flags most often
Without listing specific drug names — those change between updates and prescribers know them — here are the categories that show up most often in geriatrics conversations driven by the Beers Criteria.
- Certain sleep medicationsSome older sleeping pills (a class called benzodiazepines, and a related group sometimes called Z-drugs) carry elevated fall and confusion risk in older adults. The Beers panel routinely flags this category.
- Some antihistaminesSeveral older allergy medications — including some that are sold over the counter — have side effects that can produce confusion, dry mouth, constipation, and urinary retention in older adults.
- Certain bladder medicationsSome medications used for overactive bladder share the types of side effects. The benefit is real for some patients; in older adults the cumulative load of side effects is worth a careful look.
- Older antidepressantsA specific class of older antidepressants (tricyclics, in clinical shorthand) carries elevated risks in older adults compared with newer alternatives. Often kept on the list for reasons that made sense once and may no longer.
- Some pain medicationsCertain non-steroidal anti-inflammatory drugs (NSAIDs) carry kidney, bleeding, and cardiovascular risks that are amplified in older adults. Some opioid combinations are also flagged.
- Some heart and blood-pressure medications in specific situationsA small number of cardiovascular medications are flagged either for older adults broadly or for those with specific conditions like heart failure. The Beers entry usually names the condition.
How to bring the list into the conversation
Most prescribers are happy to talk about the Beers Criteria when the question is framed as a partnership rather than as a challenge. The phrasing that tends to work: 'I have been reading about the Beers Criteria — would it be helpful to go through the medication list together with it in mind?' That opens a conversation. The phrasing that tends not to work: 'I read on the internet that this medication is on a list.'
The most useful information to bring is the printed master medication list — drug name, strength, schedule, prescriber, reason — alongside a note that you have looked at the Beers Criteria. Many doctors will, with thirty seconds of attention, identify the one or two items on the list worth a closer conversation. Some clinics will refer the family to a geriatric pharmacist, who can run a structured medication review using the Beers Criteria as one of several tools.
When the doctor says 'I know about Beers'
Sometimes the doctor will say, plainly, 'I know about the Beers Criteria; I'm leaving this medication on the list because…' That sentence is the goal. It means the prescriber has weighed the risk, has a reason, and is willing to name it. Write the reason down in the master list. The next family member, the next pharmacist, or the next hospitalist will benefit from it being in writing.
Sometimes the conversation surfaces a real change — a medication that has outlived its purpose, a dose that can come down, a switch to a safer alternative. That is the deprescribing conversation the Beers Criteria were designed to support. It rarely happens in one visit, but it may not happen at all if the family does not raise the question.
The Beers conversation lives inside the broader annual medication review — for the deeper piece on what an annual review actually looks like, see The medication review every senior should get every year. For the related piece on why so many older adults are on more medications than they need in the first place, see What is polypharmacy — and why it's dangerous after 75. For the broader playbook this conversation feeds into, see The Caregiver's Guide to Managing Your Parent's Medications. For the longer pillar, the Medications hub has the full set.
A note on what helps: Aging Sidekick can help you turn the kitchen-counter list of medications into a clean printed list to bring to the appointment where the Beers conversation happens. We organize; doctors prescribe. Free to start. We are not a substitute for the people who make the medical calls — never change a medication regimen on your own. Always ask the doctor or pharmacist.
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