Stefanacci Richard G, Cavallaro Elizabeth, Beers Mark H, Fick Donna M
Center for Medicare MEdication Managment, University of the Sciences in Philadelphia, Philadelphia, Pennsylvania, USA.
Consult Pharm. 2009 Aug;24(8):601-10. doi: 10.4140/tcp.n.2009.601.
The Beers criteria have been extensively used over the past decade to identify and evaluate potentially inappropriate medication use in adults 65 years of age and older in the United States. In contrast to the Beers criteria, the purpose of this pilot initiative was to develop a new set of explicit criteria for determining preferred (rather then potentially inappropriate) medications to use in older adults, using similar methodology as used in the three iterations of the Beers criteria. This initiative organized its evaluations around classes of medications that are both frequently used and associated with drug-related problems in older adults-central nervous system (CNS) medications.
This pilot study used a modified Delphi method-a set of procedures and methods for reaching group consensus for a subject matter in which precise information is lacking-to determine medications that are preferred for use in persons 65 years of age or older known to have specific medical conditions. Medications were selected as preferred because they are both effective, based upon a thorough evaluation of the clinical evidence, and pose less risk for older persons compared with alternative medications for the condition. Expert panelists evaluated 78 individual medications within four medical conditions (dementia, depression, Parkinson's disease, and psychosis).
This study identified 13 preferred medications to be used in older adults with these conditions.
This study expands explicit criteria to more precisely define preferred medication use in older adults. This refinement of the Beers criteria will enable providers to select medications with the greatest benefit-to-risk ratio for older adults, thereby minimizing drug-related problems. These criteria will need to be expanded to include other medication classes and medical conditions frequently encountered in older adults.
在过去十年中，《比尔斯标准》被广泛用于识别和评估美国65岁及以上成年人中潜在的不适当用药情况。与《比尔斯标准》不同的是，本试点计划的目的是制定一套新的明确标准，以确定老年人优先使用（而非潜在不适当）的药物，采用与《比尔斯标准》三次迭代中使用的类似方法。该计划围绕老年人中常用且与药物相关问题有关的药物类别——中枢神经系统（CNS）药物——组织评估。
本试点研究采用了改良的德尔菲法——一套在缺乏精确信息的主题上达成群体共识的程序和方法——来确定已知患有特定疾病的65岁及以上人群优先使用的药物。这些药物被选为优先药物，是因为基于对临床证据的全面评估，它们既有效，又与治疗该疾病的替代药物相比，对老年人的风险更小。专家小组成员评估了四种疾病（痴呆、抑郁、帕金森病和精神病）中的78种个体药物。
本研究确定了13种优先用于患有这些疾病的老年人的药物。
本研究扩展了明确标准，以更精确地界定老年人优先用药情况。对比尔斯标准的这种细化将使医疗服务提供者能够为老年人选择效益风险比最大的药物，从而将药物相关问题降至最低。这些标准需要扩展，以纳入老年人中经常遇到的其他药物类别和疾病。
