Comparison of Two Versions of the Beers Criteria and Adverse Outcomes in Older Hospitalized Patients

To compare the performance of the 2003 and 2012 Beers criteria (BC) to predict negative clinical outcomes associated with potentially inappropriate medications in hospitalized older adults.

Retrospective cohort study.

Acute Care of Elders (ACE) unit in a community-based teaching hospital.

All patients admitted to an ACE unit who were older than 65 years of age and prescribed at least one medication upon hospital admission.

The primary outcome was hospital length of stay (LOS). Secondary outcomes included likelihood of experiencing adverse drug events (ADEs) and in-hospital mortality.

A total of 340 patients were included in this study. Inpatients prescribed a BC drug at any time had a longer hospital LOS than those not prescribed a BC drug (2003 BC: adjusted geometric mean, 5.93 vs. 5.50 days, P = 0.003; 2012 BC: adjusted geometric mean, 5.87 vs. 4.21 days, P < 0.001). Patients prescribed a 2003 BC drug had an increased risk of experiencing an ADE compared with those not prescribed a BC drug (odds ratio [OR] = 1.86, 95% confidence interval [CI] 1.11-3.11); however, this outcome was not statistically significant after adjusting for confounders (OR = 1.51, 95% CI 0.870-2.63). There was no statistically significant difference in ADEs when using the 2012 BC (adjusted OR = 1.27, 95% CI 0.689-2.33). There was no difference in hospital mortality regardless of the BC version used.

Prescription of BC drugs in an acute care setting is associated with an increased hospital LOS; however, there is no difference in the risk of ADEs or in-hospital mortality.