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The AGS Beers Criteria

The evidence base

The AGS Beers Criteria is the US reference list of medications generally best avoided in older adults. It is the most used and the most misused document in this field, and the misuse follows a predictable shape: a prompt to think gets read as a prohibition.

What it is

An explicit list of potentially inappropriate medications, produced by an interprofessional expert panel of the American Geriatrics Society through a structured evidence-review process. It is designed for adults aged 65 and older in ambulatory, acute and institutional care settings in the United States, and it explicitly excludes hospice and end-of-life care.

The current edition is the 2023 update. There is no 2026 edition. Pages circulating under that title are not AGS publications, and a page citing one is citing something that does not exist. In 2025 the AGS published a separate companion document — an Alternatives List, offering pharmacologic and non-pharmacologic substitutes for medications the criteria flag. That is a companion, not a new edition.

What it is not

The Society states its own limits more clearly than most users of the list do. The criteria “should be applied thoughtfully and in a manner that supports, rather than replaces, shared clinical decision-making.” That sentence is the whole argument about how to use it.

  • It is not a ban list. A medication on it may be exactly right for a particular person, and the criteria say so.
  • It is not a quality measure. Counting Beers-list medications and treating the count as a performance number produces pressure to stop drugs rather than to think about them.
  • It does not apply at end of life. The exclusion is explicit and it is routinely ignored.
  • It is US-specific. The European equivalent, STOPP/START, reaches partly different conclusions from partly different evidence. STOPP/START.

The correction that matters most

The most common argument built on Beers goes: adverse drug events cause about 100,000 emergency hospitalizations a year among older Americans, therefore we should reduce Beers-list prescribing. The first half is sourced. The second half does not follow from it.

The study behind that figure — national active surveillance covering adults aged 65 and over — estimated 99,628 emergency hospitalizations per year (95% CI 55,531 to 143,724) and found that four drugs or classes accounted for 67.0% of them: warfarin 33.3%, insulins 13.9%, oral antiplatelets 13.3% and oral hypoglycemics 10.7%. Medications typically designated high-risk or inappropriate were implicated in 1.2% (95% CI 0.7 to 1.7). A 2016 update using the same surveillance system found Beers “always avoid” medications implicated in 1.8% of emergency department visits for adverse drug events.

The drugs causing most drug-related emergency admissions in older adults are anticoagulants and diabetes agents — drugs that mostly should not be stopped. They need better dosing, better monitoring and better follow-up. Using the 100,000 figure to justify cutting Beers-list medications is a misuse of the study that produced it, and it points attention away from where the harm actually is.

What Beers is genuinely good for

  • Prompting a look at a list nobody has read as a whole.
  • Naming the anticholinergic drugs that other tools build exposure measures from. Anticholinergic burden.
  • Flagging central nervous system polypharmacy — three or more concurrent CNS-active medications, a threshold met by 23.2% of long-stay US nursing home residents aged 65 and over with fee-for-service Medicare in 2021 data.
  • Supplying alternatives, since 2025, rather than only prohibitions.

Common questions

Is the Beers Criteria a list of dangerous drugs?

It is a list of medications that are often inappropriate in older adults — which is a statement about a typical situation, not about a particular person. The Society itself says the criteria should support rather than replace shared clinical decision-making. A drug on the list can be the right drug for someone. The medication review.

Which version should be cited?

The 2023 update, which remains current. There is no 2026 edition, and material circulating under that name is not from the AGS. The 2025 publication is an Alternatives List companion, not a new edition of the criteria. The evidence base.

Back to the evidence base.

References

  1. By the 2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society. 2023;71(7):2052–2081. PMID 37139824 · DOI 10.1111/jgs.18372.
  2. By the 2025 AGS Alternative Treatments Panel. Alternative Treatments to Selected Medications in the 2023 American Geriatrics Society Beers Criteria. Journal of the American Geriatrics Society. 2025;73(9):2657–2677. PMID 40697073 · DOI 10.1111/jgs.19500.
  3. Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. The New England Journal of Medicine. 2011;365(21):2002–2012. PMID 22111719 · DOI 10.1056/NEJMsa1103053.
  4. Shehab N, Lovegrove MC, Geller AI, Rose KO, Weidle NJ, Budnitz DS. US Emergency Department Visits for Outpatient Adverse Drug Events, 2013-2014. JAMA. 2016;316(20):2115–2125. PMID 27893129 · DOI 10.1001/jama.2016.16201.
  5. Jung H, Liu SH, Hume AL, et al. The Prevalence of Central Nervous System-Active Polypharmacy in US Nursing Homes. Journal of the American Medical Directors Association. 2026;27(6):106178. PMID 41895707 · DOI 10.1016/j.jamda.2026.106178.
  6. O’Mahony D, Cherubini A, Guiteras AR, et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 3. European Geriatric Medicine. 2023;14(4):625–632. PMID 37256475 · DOI 10.1007/s41999-023-00777-y. See also the published correction, Eur Geriatr Med. 2023;14(4):633, PMID 37326916.

Bibliographic records on this page were retrieved from PubMed. Every reference links to its DOI or PubMed record.

Written and medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP, founder and medical director of DWARAA. Last reviewed . This page is educational. DWARAA does not prescribe, deprescribe, diagnose or treat.