Inappropriate drug prescribing in older adults: the updated 2002 Beers criteria--a population-based cohort study

Br J Clin Pharmacol. 2005 Aug;60(2):137-44. doi: 10.1111/j.1365-2125.2005.02391.x.


Background: In 1997, Beers and colleagues developed explicit criteria for potentially inappropriate drug prescribing in ambulatory older adults aged 65 years and over. Several studies have been performed to estimate the prevalence of inappropriate drug prescribing based on these criteria. In 2002, the criteria were updated.

Aims: To examine the extent and trend of inappropriate drug prescribing to ambulatory older adults in the Netherlands between 1997 and 2001, according to the 1997 and the updated Beers criteria.

Methods: Data were retrieved from the Integrated Primary Care Information (IPCI) project, a general practice research database with data from computer-based patient records of a group of 150 general practitioners in the Netherlands. All subjects aged 65 and over were included. Prescriptions were classified as inappropriate if they fulfilled the Beers criteria of prescriptions that generally should be avoided in older adults because of a high risk of adverse effects, while also considering dose and comorbidity.

Results: Between 1997 and 2001, the 1-year risk of receiving at least one inappropriate drug prescription for older adults ranged between 16.8% (95% CI: 16.3-17.3%) and 18.5% (18.3-18.7%) according to the 1997 criteria and between 19.1% (18.6-19.6%) and 20.0% (19.5-20.5%) according to the updated Beers criteria. According to the updated criteria, the most frequently prescribed inappropriate drugs were nitrofurantoin, long-acting benzodiazepines, amitriptyline, promethazine and cimetidine. Temazepam and zolpidem were mostly prescribed in supratherapeutic dose. Conventional NSAIDs in persons with a history of gastric/duodenal ulcer were the most frequently prescribed contra-indicated drugs.

Conclusions: Prescribing potentially inappropriate prescriptions to ambulatory older people in the Netherlands is substantial. Compared with other studies using the 1997 Beers criteria, inappropriate prescribing to the elderly is lower than in the USA but similar to Finland. Despite a restrictive medication policy and a growing attention for medication surveillance in Europe, inappropriate drug prescribing is still a substantial problem.

MeSH terms

  • Aged
  • Amitriptyline / adverse effects
  • Amitriptyline / therapeutic use
  • Anti-Infective Agents, Urinary / adverse effects
  • Anti-Infective Agents, Urinary / therapeutic use
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Antidepressive Agents, Tricyclic / adverse effects
  • Antidepressive Agents, Tricyclic / therapeutic use
  • Antipruritics / adverse effects
  • Antipruritics / therapeutic use
  • Benzodiazepines / adverse effects
  • Benzodiazepines / therapeutic use
  • Cimetidine / adverse effects
  • Cimetidine / therapeutic use
  • Cohort Studies
  • Comorbidity
  • Drug Prescriptions*
  • Drug Therapy, Combination
  • Enzyme Inhibitors / adverse effects
  • Enzyme Inhibitors / therapeutic use
  • Female
  • Humans
  • Hypnotics and Sedatives / adverse effects
  • Hypnotics and Sedatives / therapeutic use
  • Male
  • Medication Errors*
  • Netherlands / epidemiology
  • Nitrofurantoin / adverse effects
  • Nitrofurantoin / therapeutic use
  • Promethazine / adverse effects
  • Promethazine / therapeutic use
  • Pyridines / adverse effects
  • Pyridines / therapeutic use
  • Risk Assessment / methods
  • Zolpidem


  • Anti-Infective Agents, Urinary
  • Anti-Inflammatory Agents, Non-Steroidal
  • Antidepressive Agents, Tricyclic
  • Antipruritics
  • Enzyme Inhibitors
  • Hypnotics and Sedatives
  • Pyridines
  • Benzodiazepines
  • Amitriptyline
  • Zolpidem
  • Cimetidine
  • Nitrofurantoin
  • Promethazine