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Research in geriatric pharmacology is not keeping pace with approvals of new drugs, making it difficult for clinicians to best use newer treatment options.Drug dose adjustments are almost always based on creatinine clearance, and e GFR over-estimates creatinine clearance, potentially resulting in too high a dose or inappropriate drug selection.The drugs included in the tables on drugs to avoid or reduce dosage based on kidney function were primarily based on those identified by a separate consensus panel of geriatricians and geriatric pharmacy practitioners as drugs whose dose should be adjusted to avoid harms.For example, anticoagulants and diabetes medications have significant side effects that have been shown to lead to ER visits in the elderly.Whenever starting a new medication or increasing the dose of an existing medication, the prescriber and the pharmacist should monitor the patient for efficacy and toxicity and educate the patient and family/caregiver about the effects of the medication. Beizer, Pharm D, CGP, FASCP, AGSF, is a Clinical Professor and Assistant Chair of the Department of Clinical Health Professions at the College of Pharmacy and Health Sciences, St. She also practices as a clinical pharmacist at the Stern Family Center for Rehabilitation, part of Northwell Health. Beizer served on the Expert Panel for the 20 AGS Beers Criteria and is one of the editors of the Lexicomp Geriatric Dosage Handbook, currently in its 21st edition. When looking at the problems plaguing American healthcare and the potential contributions of pharmacists to help improve patient outcomes, experts often repeat the same refrains: encourage better patient medication adherence; offe...The important thing to remember is that the medications on the Beers Criteria are inappropriate, not definitely.We like to say that the Beers Criteria should be used as a “warning light.” If a prescriber is thinking of using one of these medications, he or she should stop and review why it’s on the list, read the rationale and caveats, and weigh the risk-benefit ratio.This is not meant to imply that opioids should always be avoided.They have a place in pain management (and pain can increase the risk of falls).What is concerning is that these agents — for example, antipsychotics used to treat delirium — may be less useful, and thus more harmful, than previously thought.When considering a medication that is not included in the Criteria, clinicians can apply what they know of the drug’s potential adverse effects on the general population.