Medications do not come without risk but you may need them just the same. Depending on your age and any medical conditions you have, certain treatments could not only extend your life but may improve the quality of it too. This trick is to use as few high-risk medications as possible.

Chronic Conditions & Drug Use

As many as 89% of people 65 and older take at least one prescription medication. More than half (54%) take four or more! Each prescription medication has its own side effect profile and medications taken together increase the risk for drug-drug interactions. Let us not forget that over-the-counter medications, even herbal supplements, can cause their own problems. “Natural” does not necessarily mean safe.

Not only do older adults take more medications, they also have more health problems. It is part of the aging process. According to the Centers for Disease Control and Prevention, 87.6% percent of people 65 and older have at least one chronic medical condition. Approximately 2 in 3 (63.5%) have two or more. Certain medications may cause complications depending on what medical problems you have.

Beers Criteria

It is never advised that you take beer with your medications. It is also recommended that you decrease use of any medications that fall under Beers criteria — a beer of another name! Dr. Mark Beers, a geriatrician, created this evidence-based criteria in 1991 to decrease risky medication use in seniors. The initial criteria focused on people living in long-term care facilities. The criteria have since expanded to include medication use wherever you are — in a hospital, a skilled nursing facility, or at home.

The updated 2023 criteria included more than 100 drugs across three categories:

• Potentially inappropriate medications to avoid in older adults
• Potentially inappropriate medications to avoid in older adults with certain diseases/syndromes
• Medications to use with caution in older adults

Check the list to see if you are on any of them. Keep in mind the list does not mean these medications should never be prescribed. Sometimes, there are literally no other options. These criteria guide your healthcare provider to consider alternative treatments whenever possible. If they do prescribe them, they should monitor you closely to make sure you do not have serious side effects.

Medicare Advantage vs. Part D

Is your health plan paying attention to what your doctor prescribes? When it comes to Medicare Advantage and Part D plans, you bet. That’s because these plans, run by private insurance companies, are monitored by the National Committee for Quality Assurance (NCQA) to make sure they meet quality standards and maintain patient satisfaction. To that end, they rely on HEDIS (Healthcare Effectiveness Data and Information Set) to track performance. HEDIS and Beers criteria go hand in hand.

Interestingly, a JAMA study found that Medicare Advantage plans filled fewer high-risk medications than Part D plans — 41.5 prescriptions per 1,000 people vs. 56.9 per 1,000 people. Women and people who were dual eligible (on both Medicare and Medicaid) tended to have higher rates of high-risk medication use. There were also racial disparities with Asian, Black, and Hispanic people receiving fewer and American Indian or Alaska Native people receiving more high-risk medications than White people. The researchers suggest that these differences could relate to affordability of these medications (e.g., medications were prescribed but people could not afford them) or even access to health care (e.g., medications were not prescribed because people did not have the same number of office visits where they could have been prescribed).

To meet the HEDIS standards and to keep THEIR own drug costs down (e.g., they are not always worried about YOUR drug costs), many Medicare Advantage and Part D plans rely on prior authorizations. This process allows them to be more directly involved in the prescription process. Simply put, they can refuse to cover certain prescriptions unless criteria are met. (Too often, this process also keeps medically necessary medications out of the hands of the people that need them.)

Part D plans can only set rules for the drugs themselves, not for the doctors who prescribe them. Medicare Advantage plans, however, can incentivize doctors to keep costs down too. The study results may be explained by the fact that Medicare Advantage plans have a two-pronged reach when it comes to your medications, influencing not only what drugs are covered but also how your doctor prescribes them.

American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. (2023). https://doi.org/10.1111/jgs.18372

Boersma, P., Black, L. I., & Ward, B. J. (2020). Prevalence of Multiple Chronic Conditions Among US Adults, 2018. Research Brief, vol. 17. https://doi.org/10.5888/pcd17.200130

Data Note: Prescription Drugs and Older Adults. (2019). KFF. https://www.kff.org/health-reform/issue-brief/data-note-prescription-drugs-and-older-adults/

Figueroa, J. F., Dai, D., Yevgeniy Feyman, Garrido, M. M., Tsai, T. C., E John Orav, & Frakt, A. B. (2023). Use of High-Risk Medications Among Older Adults Enrolled in Medicare Advantage Plans vs Traditional Medicare. 6(6), e2320583–e2320583. https://doi.org/10.1001/jamanetworkopen.2023.20583

Medication Management in Older Adults. National Committee for Quality Assurance. https://www.ncqa.org/hedis/measures/medication-management-in-older-adults/