**4. Medication classes with anticholinergic effects- the Beer's list of potentially inappropriate medications in older adults**

In 1991, Dr. Mark Beers published explicit criteria for the use of 'potentially inappropriate medications' or PIMS in older nursing home residents [20]. The

*Assessing Anticholinergic Effects in Older Adults DOI: http://dx.doi.org/10.5772/intechopen.94555*


#### **Table 2.**

*Beer's list drugs with strong anticholinergic properties.*

Beer's criteria, which were developed using a two-stage Delphi survey, defined inappropriate prescribing as the use of a medication where the potential risks outweigh the potential benefits. These initial criteria included 30 therapeutic classes/medications that should be avoided in elderly nursing home residents [21]. This list is updated every 3 years by the American Geriatrics Society. At the time of this writing, the latest Beer's List was published in 2019. The criteria identifies PIMs, drugs that may be PIMS because they may exacerbate disease states or geriatric syndromes, drugs that should be used with caution, drugs that should be avoided, drugs that should be used in reduced doses (if at all) based on renal function, and drugs with strong anticholinergic properties **Table 2** [22].
