LAUSR

Consensus criteria (as well as clinical practice guidelines) have the potential to improve quality of care and outcomes that are important to patients. They also may have substantial downsides. Even when applied correctly, unintended consequences can occur. Yet perhaps a bigger problem is their misuse, misapplication, and a lack of understanding of the ideal use of clinical recommendations and guidelines. The American Geriatrics Society (AGS) guiding principles for patients with multiple chronic conditions summarize some of the pitfalls of following diseasespecific guidelines when treating complex, frail older adults. Recommendations intended to be applied with attention to individual patient circumstances can be treated as “black or white,” with little room for clinical nuance and individualized person-centered care. And attempts to improve care quality by translating consensus recommendations into quality measures and point-of-care reminders can sometimes incentivize care in harmful ways. The solution is not to give up on developing recommendations to guide individual clinicians in clinical practice or on the quality measures entirely, but to find an appropriate middle path that delineates their optimal use and balances the imperatives of quality improvement with clinical nuance— supporting clinicians and the healthcare system to carry out the right action for the right patient at the right time. The 2019 AGS Beers Criteria is a list of criteria that provides recommendations for medications that should often be avoided for older adults. These criteria, developed through a modified Delphi consensus process, is no exception to the potential for promises and pitfalls. To promote optimal use of the criteria, in 2015 a subgroup of the update expert panel published a companion paper, “How to Use the American Geriatrics Society 2015 Beers Criteria—A Guide for Patients, Clinicians, Health Systems, and Payors.” Coincident with the release of the current update, we wish to remind readers of the seven key principles articulated in that companion paper (Table 1). These principles are intended to guide use of the AGS Beers Criteria in a way that maximizes their benefits while minimizing unintended harms, and reflects the spirit in which they were developed. The justright porridge is waiting. We encourage you to eat. +++++