Drug-Disease Interactions of Concern in Older Adults (Based on the American Geriatrics Society 2019 Beers Criteria^® Update)

Cardiovascular

Heart failure

May promote fluid retention and/or exacerbate heart failure (NSAIDs, COX-2 inhibitors, nondihydropyridine calcium channel blockers, and thiazolidinediones)

Syncope

Increased risk of orthostatic hypotension or bradycardia

Central nervous system

Delirium

Worsened delirium in older adults with or at high risk of delirium

Antipsychotics increase risk of stroke and mortality in patients with dementia and should be avoided for behavioral problems of delirium unless nonpharmacologic options (eg, behavioral interventions) have failed or are not possible and patient is threatening substantial harm to self or others

Dementia and cognitive impairment

Adverse CNS effects

Antipsychotics increase risk of stroke and mortality in patients with dementia and should be avoided for behavioral problems of dementia unless nonpharmacologic options (eg, behavioral interventions) have failed or are not possible and patient is threatening substantial harm to self or others

History of falls or fractures

Ataxia, impaired psychomotor function, syncope, and additional falls

Shorter-acting benzodiazepines are not safer than long-acting ones

If one of the drugs must be used, reduce use of other CNS-active drugs that increase risk of falls and fractures and implement other fall risk reduction strategies; data for antidepressants are mixed but no compelling evidence indicates that certain antidepressants confer less fall risk than others

Avoid antiseizure drugs except for seizure and mood disorders

Avoid opioids except for pain management in the setting of severe acute pain, such as pain due to recent fractures or joint replacement

Parkinson disease

Gastrointestinal

History of gastric or duodenal ulcers

Exacerbate existing ulcers or cause new ulcers

Kidney and Urinary Tract

Chronic kidney disease (stage IV or higher: creatinine clearance < 30 mL/min [0.5 mL/sec])

NSAIDs (non-COX and COX-selective, oral and parenteral, nonacetylated salicylates)

May increase risk of acute kidney injury and further decline of renal function

Urinary incontinence (all types) in women

Lack of efficacy (oral estrogen)

Worsened incontinence (alpha-1-blockers)

Lower urinary tract symptoms, benign prostatic hyperplasia

Drugs that have strong anticholinergic effects (except antimuscarinics for urinary incontinence)

May decrease urinary flow and cause urinary retention in men