Preamble

In 2012, the American Geriatrics Society (AGS) published the most recent update of the "Beers Criteria for Potentially Inappropriate Medication (PIM) Use in Older Adults". In 2015, the AUA published the "AUA White Paper on the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults" because several medications included in sections of the Beers Criteria are frequently used in clinical urology, including nitrofurantoin, the alpha1 blocker medications, and the antimuscarinic anticholinergic medications for the treatment of urge incontinence and overactive bladder.

The goal of the Beers Criteria is to improve the effectiveness and safety of prescription practices for geriatric patients. The AGS has noted that the Beers Criteria should never be used to supersede clinical judgment and individualized patient care. The AGS does not endorse the use of the Beers Criteria to certify medications as "never appropriate" for older persons. Based on both expert opinion and existing published evidence, the Beers Criteria acknowledge that PIMs may be appropriately prescribed under certain circumstances with shared decision-making between the prescribing clinician and patient.

Declarations

The American Urological Association, Inc.® (AUA) endorses the statement of the American Geriatrics Society in "American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults" regarding the Beers Criteria as follows:

The updated [Beers] criteria should be viewed as a guideline for identifying medications for which the risks of their use in older adults outweigh the benefits...

This list is not meant to supersede clinical judgment or an individual patient's values and needs. Prescribing and managing disease conditions should be individualized and involve shared decision-making. The historical lack of inclusion of many older adults in drug trials and the related lack of alternatives in some individual instances further complicate medication use in older adults. There may be cases in which the healthcare provider determines that a drug on the list is the only reasonable alternative (e.g., end-of-life or palliative care).The panel has attempted to evaluate the literature and best-practice guidelines to cover as many of these instances as possible, but not all possible clinical situations can be anticipated in such a broad undertaking. In these cases, the list can be used clinically not only for prescribing medications, but also for monitoring their effects in older adults. If a provider is not able to find an alternative and chooses to continue to use a drug on this list in an individual patient, designation of the medication as potentially inappropriate can serve as a reminder for close monitoring so that [adverse drug events] can be incorporated into the electronic health record and prevented or detected early.

Furthermore, the AUA endorses the American Medical Association's Policy H-185.40 "Beers or Similar Criteria and Third Party Payer Compliances Activities" Policy as follows:

Our AMA adopts policy: (1) discouraging health insurers, benefit managers, and other payers from using the Beers Criteria and other similar lists to definitively determine coverage and/or reimbursement, and inform health insurers and other payers of this policy; and (2) clarifying that while it is appropriate for the Beers Criteria to be incorporated in quality measures, such measures should not be applied in a punitive or onerous manner to physicians and must recognize the multitude of circumstances where deviation from the quality measure may be appropriate, and inform health insurers and other payers of this policy. (BOT Rep. 14, A-12)

Furthermore, the AUA opposes the use of pre- or prior-authorizations for medications solely because the medication is included in the Beers Criteria, or in the CMS High Risk Medications lists derived from the Beers Criteria, as the Beers Criteria were not developed to preclude a medication from being prescribed. The Beers Criteria should never be used to supersede clinical judgment and individualized patient care.

Board of Directors, 2016