This post is for consultant pharmacists, clinical pharmacy directors, and the Directors of Nursing and administrators who rely on their medication regimen reviews. You will get a practical orientation to the 2023 Beers Criteria update, what shifted from prior editions, and how to fold those changes into a defensible geriatric medication review workflow. This is general professional education, not patient-specific clinical advice.
What the Beers Criteria are — and what they are not
The American Geriatrics Society (AGS) Beers Criteria are a consensus list of potentially inappropriate medications (PIMs) in adults 65 and older. They flag drugs and drug classes where the risks may outweigh the benefits, drugs to use with caution, drug-disease and drug-drug interactions of concern, and medications that warrant dose adjustment in reduced renal function.
The word potentially matters. The Beers Criteria are a screening and decision-support tool, not a mandate. The consultant pharmacist evaluates whether a flagged medication is appropriate for a specific resident given diagnoses, goals of care, and monitoring — the criteria inform judgment, they do not replace it.
The AGS periodically updates the criteria as evidence evolves. Always confirm the current, authoritative content against the AGS publication itself rather than a secondhand summary, because entries are added, removed, and reworded between editions.
What changed in the 2023 Beers Criteria update
The 2023 revision continued the AGS's pattern of refining rather than rebuilding. At a high level, the update reflected newer evidence by adjusting which agents appear on each list, clarifying the rationale statements, and sharpening the language around when caution — rather than avoidance — is the right frame. Several themes are worth understanding as principles you apply.
- Anticoagulation nuance. Guidance around anticoagulant selection in older adults continued to evolve, with attention to agent-specific considerations rather than blanket avoidance.
- Refined class-level language. Recommendations were reworded in places to distinguish "avoid" from "use with caution" and to tie cautions more explicitly to comorbidities and monitoring.
- Renal dosing considerations. The criteria continued to emphasize medications that warrant dose review or avoidance when kidney function is reduced — a recurring pressure point in both long-term care and dialysis populations.
- Drug-drug interaction focus. Combinations that compound sedation, bleeding, or fall risk remained a priority area for review.
Because the specific additions and removals change between editions, treat any list you memorized from a prior version as stale. Pull the current entries from the AGS source and reconcile your internal review templates against them.
Why the update matters for SNF and long-term care
In skilled nursing and long-term care (SNF), the Beers Criteria intersect directly with the medication regimen review (MRR) the consultant pharmacist performs and with survey expectations around unnecessary drugs, adverse consequences, and gradual dose reduction (GDR) for psychotropics. When your PIM screening lags behind the current criteria, two problems follow: you may miss a newly flagged agent, and your documentation may cite reasoning the current evidence no longer supports.
CMS regulates medication management in long-term care through its State Operations Manual and associated F-tags. The Beers Criteria are not themselves a CMS regulation, but surveyors and clinicians widely treat them as a recognized standard for identifying potentially inappropriate prescribing in older adults. For the authoritative regulatory requirements, consult CMS directly, and remember that both the regulations and the clinical criteria are periodically revised.
Keeping your MRR aligned to the 2023 Beers Criteria update strengthens the clinical rationale behind each recommendation — which is exactly what supports the recommendation when a prescriber or surveyor asks "why." See how this fits a purpose-built long-term care workflow on the SNF solution page.
How to operationalize the 2023 update in your reviews
Turning a criteria update into consistent practice is a process problem, not just a clinical one. A workable approach:
- Reconcile your source of truth. Compare your current screening list against the 2023 AGS publication and note every add, remove, and reworded rationale.
- Update your review template. Ensure the language you use in recommendations reflects the current "avoid" versus "use with caution" framing, not last edition's phrasing.
- Layer complementary tools. Beers is one lens. Pairing it with STOPP/START (Screening Tool of Older Persons' Prescriptions / Screening Tool to Alert to Right Treatment) v2 and an anticholinergic burden (ACB) assessment gives a fuller view of PIMs, prescribing omissions, and cumulative anticholinergic load.
- Document the judgment, not just the flag. A flag alone is not a recommendation. Record why the flagged agent is or is not appropriate for the individual, what monitoring applies, and what alternative was considered.
- Close the loop. Track prescriber response and follow-up so a recommendation does not disappear into a chart.
Beers, STOPP/START, and ACB together
No single instrument catches everything. The Beers Criteria emphasize PIMs and drug-disease cautions in a U.S. context. STOPP/START v2 adds an explicit focus on prescribing omissions — medications a resident arguably should be receiving but is not — alongside stop criteria. ACB scoring surfaces the cumulative anticholinergic burden that contributes to cognitive and fall risk and that no single-drug flag fully captures.
Used together, these tools let the consultant pharmacist build a layered, defensible picture of a regimen. That layered approach is the backbone of a rigorous geriatric medication review, and it is where consistency across a caseload pays off. You can see how these clinical lenses come together in a single workflow on the platform overview.
Keep pace as criteria evolve
The practical takeaway from any Beers update is discipline: verify against the authoritative source, refresh your templates, and keep your reasoning current. Criteria change, evidence changes, and your documented rationale should reflect today's standard rather than yesterday's habit.
How WeConsultRx helps. The WeConsultRx clinical engine codifies 49 rules across Beers 2023, STOPP/START v2, and anticholinergic burden, so your reviews are screened consistently against current criteria and every flag ties back to a documented rationale you sign off on. Explore the clinical engine and features, or request a demo to see it applied to your caseload.