Key Takeaways from AGS's Updated Beers' Criteria for Alternative Treatments to Select Medications, Heart Failure, Pain, Genitourinary Symptoms of Menopause, and Anxiety

Guidelines

Published: August 27, 2025

Beers' Criteria for Applying Alternative Recommendations in Clinical Practice

Beers' Criteria for Anxiety Symptoms

Beers' Criteria for Pain

Beers' Criteria for Heart Failure

Beers' Criteria for Genitourinary Symptoms of Menopause

Guideline Resources

Title: Alternative Treatments to Selected Medications in the 2023 American Geriatrics Society Beers Criteria
Society: American Geriatrics Society (AGS)
Publish Date: July 23, 2025
Summary
Full-text

Video Transcription

Today we’re kicking off our series on The American Geriatric Society’s newest updates on Alternative Treatments to Selected Medications from the 2023 AGS Beers’ Criteria.

This criteria serves to identify medications whose potential for harm outweighs their in- tended benefit in older adults. This report presents these in a manner intended to be easily usable by front-line clinicians facing common clinical scenarios. The list includes pharmacologic alternatives to medications on the AGS Beers Criteria® as well as non-pharmacologic management strategies that are often safer and equally or more effective than the potentially inappropriate medications they are replacing.

Principles for Applying Alternative Recommendations in Clinical Practice

In this video, Part 1 of 5, — we’ll be discussing Principles for Applying Alternative Recommendations in Clinical Practice.

There are 5 principles so Let’s get started.

For the first principle, Stopping a potentially inappropriate medication is not the end goal.
- The goal is to provide non-pharmacologic and/or pharmacologic management that helps people feel better and maintain health while reducing their risk of medication-associated harms.
For the second, Instead of replacing a potentially inappropriate medication with a “better” one, consider non-pharmacologic strategies where appropriate.
- Such strategies are often more effective and safer than medications for managing common chronic conditions.
The third principle states that understanding the underlying cause(s) of a symptom or condition can help guide therapy.
The 4th says, Potentially inappropriate medications should often be avoided, but not always.
- Clinician judgement, consideration of individual circumstances, and shared decision-making should be used when selecting among treatment options.
And last, the fifth principle, Make use of resources and supports to aid deprescribing.

And that wraps up Part 1 of our 5-part series on the AGS Beers Criteria® alternatives recommendations. Make sure to watch the next video where we’ll cover anxiety symptoms, and to explore the full guideline from The American Geriatrics Society and other clinical decision support tools, check it out at guidelinecentral.com.

Anxiety Symptoms

Welcome back to part 2 of our 5-part series on The American Geriatric Society’s newest guidelines on Alternative Treatments to Selected Medications from the 2023 American Geriatrics Society Beers Criteria. In Part 1, we introduced the series and explored Principles for Applying Alternative Recommendations in Clinical Practice. Today, we’re shifting our focus to individuals with Anxiety Symptoms.

For individuals with anxiety symptoms, there are 5 key points.

The AGS Beers Criteria states to Avoid the following,

Avoid
- Avoid benzodiazepines
- Avoid 1st generation antihistamines
- Avoid TCAs
- Avoid barbiturates
- Avoid meprobamate

The AGS Beers Criteria states to:

Clarify the presence of any underlying psychiatric disorder
- Some anxiety symptoms may be a response to life events, and may be addressed through non-pharmacologic approached
Evaluate other conditions that may be contributing to anxiety

It also states:

Non-pharmacologic interventions are 1st line for many psychiatric disorders that present with anxiety.
- Tailor treatment to the diagnosis

And last,

When pharmacologic therapy is initiated, consider agents with a safer adverse effect profile

And that wraps up Part 2 of our 5-part series on the AGS Beers Criteria® alternatives recommendations. Make sure to watch the next video where we’ll cover the topic of pain, and to explore the full guideline from The American Geriatrics Society and other clinical decision support tools, check it out at guidelinecentral.com.

Pain

Welcome to Part 3 of our 5-part series on The American Geriatric Society’s newest updates on Alternative Treatments to Selected Medications from the 2023 AGS Beers’ Criteria. Today, we’re diving into Pain.

The AGS’ Beers’ Criteria states to avoid the following:
Avoid

Avoid tricyclic antidepressants
Avoid meperidine
Avoid non-Cox-2 selective NSAIDS for chronic use, and short term schedules use in combination with systemic steroids, anticoagulants, or antiplatelets in most cases
Avoid skeletal muscle relaxants
Avoid combinations of gabapentinoids with opioids or benzodiazepines

The criteria also says to:

Assess pain before and after treatment to identify response, with the goal of improving function
For 1st line management of chronic pain, consider non-pharmacological approaches, alone or in combination with medications
- Non-pharmacologic options for chronic pain vary, and may include: education interventions, exercise therapy,, physical therapy interventions, acupuncture, psychological interventions, peripheral electric and/or magnetic stimulation, and repetitive transcranial magnetic stimulation (rTMS)

It also states:

Pharmacologic approaches should be targeted to the type of pain
- For nociceptive pain:
  - Instead of meperidine, choose a different opioid
  - Instead of skeletal muscle relaxants or long-term use of NSAIDs, consider the following: short term NSAIDs, topical NSAIDs, COX-2 selective inhibitors, capsaicin, rubefacients and related agents (e.g., menthol-containing ointments), lidocaine, acetaminophen, intra-articular corticosteroids
- For neuropathic pain:
  - Instead of TCAs, consider the following: SNRIs, gabapentinoids, capsaicin, rubefacients and related agents (e.g., menthol-containing ointments), lidocaine

And that wraps up Part 3 of our 5-part series on the AGS Beers Criteria® alternatives recommendations. Make sure to watch the next video where we’ll cover the topic of heart failure, and to explore the full guideline from The American Geriatrics Society and other clinical decision support tools, check it out at guidelinecentral.com.

Heart Failure

Welcome to Part 4 of our 5-part series on The American Geriatric Society’s newest updates on Alternative Treatments to Selected Medications from the 2023 AGS Beers’ Criteria. In the last few videos, we’ve walked through pain, anxiety symptoms, and principles for applying alternative recommendations in clinical practice, and today we’ll take a closer look at heart failure.

The criteria states the following:

Avoid digoxin as 1st line therapy for AF or HF

Initiate GDMT for HFrEF before considering digoxin
1st line agents include:
- sacubitril/valsartan (or an ACEI/ARB if sacubitril/valsartan is not tolerated or unaffordable),
- beta blocker,
- MRA
- SGLT2i
- Hydralazine-nitrates for black patients with NYHA class III-IV HFrEF
For fluid retention, use diuretics as needed.
Non-pharmacologic adjuncts for HFrEF include cardiac resynchronization therapy (CRT) and referral to cardiologist

And that wraps up Part 4 of our 5-part series on the AGS Beers Criteria® alternatives recommendations. Make sure to watch the next video where we’ll cover our last topic on genitourinary symptoms of menopause, and to explore the full guideline from The American Geriatrics Society and other clinical decision support tools, check it out at guidelinecentral.com.

Genitourinary Symptoms of Menopause

Welcome to the final installment in our 5-part series on the The American Geriatric Society’s newest updates on Alternative Treatments to Selected Medications from the 2023 AGS Beers’ Criteria, and today we’re wrapping things up with genitourinary symptoms of menopause.

There are 4 key takeaways, so let’s get started