Beers Criteria: Elderly PI Medication Evidence Attorneys Should Know

Amar Lunagaria — Co-Founder & Chief Pharmacist, LienScripts | March 4, 2026 | 8 min read

The American Geriatrics Society Beers Criteria is the definitive clinical guideline identifying medications that are potentially inappropriate for elderly patients. In personal injury cases involving older adults, the Beers Criteria creates a clinical framework that can both support and complicate the damages narrative — and PI attorneys need to understand how it works.

Beers Criteria: Elderly PI Medication Evidence Attorneys Should Know

The American Geriatrics Society (AGS) Beers Criteria is a consensus-based list of medications that are potentially inappropriate for adults aged 65 and older due to elevated risk of adverse effects, drug-drug interactions, or limited efficacy in the geriatric population. When a personal injury plaintiff is an elderly patient, the Beers Criteria becomes a critical clinical reference that affects prescribing decisions, shapes the medication regimen, and creates both opportunities and challenges for the damages narrative.

• The Beers Criteria identifies medications that carry elevated risks for patients 65 and older, directly affecting prescribing in elderly PI cases
• Elderly plaintiffs often require more expensive, carefully selected medications because Beers-listed drugs are contraindicated, which increases treatment complexity
• Defense attorneys may use Beers Criteria to challenge specific medications on the lien, arguing they are inappropriate for the patient's age
• The Beers Criteria can also support the plaintiff's case by documenting why more complex and costly treatment was medically necessary
• As Amar Lunagaria, PharmD, LienScripts' Chief Pharmacist explains, understanding Beers Criteria medications gives attorneys a clinical framework for explaining why elderly plaintiffs need different — and often more expensive — treatment approaches

What the Beers Criteria Covers

The Beers Criteria categorizes potentially inappropriate medications into several groups:

Medications to avoid in most older adults. These include certain benzodiazepines, first-generation antihistamines like diphenhydramine, skeletal muscle relaxants like cyclobenzaprine and metaxalone, and certain non-steroidal anti-inflammatory drugs (NSAIDs) used chronically. Each carries age-specific risks including falls, cognitive impairment, GI bleeding, and renal injury.

Medications to avoid in older adults with specific conditions. For example, NSAIDs are listed as potentially inappropriate for elderly patients with heart failure or chronic kidney disease. Certain antipsychotics carry heightened risks in patients with dementia. These condition-specific cautions are particularly relevant in PI cases where the plaintiff has pre-existing comorbidities.

Medications to use with caution. Some drugs are not absolutely contraindicated but require careful monitoring. These include certain antidepressants, diuretics, and antihypertensives that increase fall risk.

Drug-drug interactions to avoid. The Beers list identifies specific medication combinations that are particularly dangerous in elderly patients, including concurrent use of multiple CNS depressants or combining certain cardiovascular medications.

How Beers Criteria Affects Elderly PI Cases

Treatment complexity increases. When a 72-year-old plaintiff suffers a car accident with lumbar disc herniation and chronic pain, the treating physician cannot simply prescribe the same regimen they would for a 35-year-old. Cyclobenzaprine — a standard muscle relaxant — is Beers-listed due to fall risk and anticholinergic effects. Chronic NSAID use is Beers-listed due to GI and renal risk. The physician must navigate around these restrictions, often selecting more targeted, more expensive, or less commonly used alternatives.

This treatment complexity is itself a damages element. The plaintiff's age requires a more carefully managed, more frequently monitored, and often more costly medication regimen — all direct consequences of the injury interacting with the plaintiff's age-related clinical profile.

Prescribing choices document clinical reasoning. When a physician avoids a Beers-listed medication and selects an alternative, that prescribing decision documents the physician's clinical reasoning. The fact that the physician chose a more expensive CGRP inhibitor for migraine instead of a Beers-listed tricyclic antidepressant is not billing maximization — it is age-appropriate prescribing that follows national guidelines.

Monitoring requirements increase. Elderly patients on post-injury medications require more frequent lab monitoring, more specialist visits, and more pharmacist interventions for drug interaction screening. Each of these monitoring events adds to the medical cost of the case and to the treatment burden on the plaintiff. For more on how medication complexity translates to damages, see Medication Regimen Complexity Index Scoring.

Defense Use of Beers Criteria

Defense attorneys may attempt to use the Beers Criteria offensively by arguing that a Beers-listed medication on the pharmacy lien was inappropriately prescribed to the elderly plaintiff. This argument essentially claims the treating physician made a prescribing error.

The response is nuanced. The Beers Criteria uses the word "potentially" inappropriate because clinical judgment may override the general recommendation for individual patients. A physician who prescribes a Beers-listed medication after weighing the risks and benefits for a specific patient is exercising clinical judgment, not violating a guideline. The treating physician's documentation of why the medication was selected despite its Beers status is the key piece of evidence.

LienScripts generates a MERIT (Medication Evaluation & Rationale for Injury Treatment) report for every case, providing pharmacist-signed documentation for demand packages. For elderly patients, the MERIT documentation addresses Beers Criteria considerations — explaining why specific medications were selected and how the treatment plan accounts for age-related risks.

Practical Takeaway

When representing an elderly PI plaintiff, attorneys should understand that the medication regimen will likely look different from a younger plaintiff's regimen — not because the injury is less severe, but because age-appropriate prescribing requires navigating clinical restrictions that increase treatment complexity and cost. This is a damages argument, not a defense argument. For related discussion on how fall-risk medications create secondary injury evidence in elderly patients, see Fall-Risk Medications and the Elderly Secondary Injury Chain.

Contact LienScripts to discuss how clinical pharmacy expertise supports medication management for elderly personal injury plaintiffs.