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<article article-type="review-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">safetyrisk</journal-id><journal-title-group><journal-title xml:lang="ru">Безопасность и риск фармакотерапии</journal-title><trans-title-group xml:lang="en"><trans-title>Safety and Risk of Pharmacotherapy</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2312-7821</issn><issn pub-type="epub">2619-1164</issn><publisher><publisher-name>Federal State Budgetary Institution ‘Scientific Centre for Expert Evaluation of Medicinal Products’ of the Ministry of Health of the Russian Federation (FSBI ‘SCEEMP’)</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.30895/2312-7821-2024-420</article-id><article-id custom-type="elpub" pub-id-type="custom">safetyrisk-420</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ГЛАВНАЯ ТЕМА: РАЗУМНАЯ ДОСТАТОЧНОСТЬ КАК ПРИНЦИП ЛЕКАРСТВЕННОЙ ТЕРАПИИ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>MAIN TOPIC: REASONABLE SUFFICIENCY AS A PRINCIPLE OF PHARMACOTHERAPY</subject></subj-group></article-categories><title-group><article-title>Потенциально не рекомендованные лекарственные средства для применения у пациентов пожилого возраста: критерии Бирса (рекомендации Американского гериатрического общества 2023 г.)</article-title><trans-title-group xml:lang="en"><trans-title>Potentially Inappropriate Medications for Use in Older Adults: Beers Criteria (2023 American Geriatrics Society Guidelines)</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-4496-3680</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Сычев</surname><given-names>Д. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Sychev</surname><given-names>D. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Сычев Дмитрий Алексеевич, академик РАН, д-р мед. наук, профессор</p><p>ул. Баррикадная, д. 2/1, стр. 1, Москва, 125993</p></bio><bio xml:lang="en"><p>Dmitry A. Sychev, Academician of the Russian Academy of Sciences, Dr. Sci. (Med.), Professor</p><p>2/1/1 Barrikadnaya St., Moscow 125993</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-3091-7904</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Черняева</surname><given-names>М. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Cherniaeva</surname><given-names>M. S.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Черняева Марина Сергеевна, канд. мед. наук, доцент</p><p>ул. Маршала Тимошенко, д. 19, стр. 1А, Москва, 121359Волгоградский пр-т, д. 168, Москва, 109472</p></bio><bio xml:lang="en"><p>Marina S. Cherniaeva, Cand. Sci. (Med.), Associate Professor</p><p>19/1A Marshal Timoshenko St., Moscow 121359168 Volgogradsky Ave, Moscow 109472</p></bio><email xlink:type="simple">doctor@cherniaeva.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0001-9329-7477</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Рожкова</surname><given-names>М. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Rozhkova</surname><given-names>M. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Рожкова Мария Александровна</p><p>ул. Маршала Новикова, д. 23, Москва, 123098</p></bio><bio xml:lang="en"><p>Maria A. Rozhkova</p><p>23 Marshal Novikov St., Moscow 123098</p></bio><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-1183-4716</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Воробьева</surname><given-names>А. Е.</given-names></name><name name-style="western" xml:lang="en"><surname>Vorobyova</surname><given-names>A. E.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Воробьева Анастасия Евгеньевна</p><p>ул. Баррикадная, д. 2/1, стр. 1, Москва, 125993</p></bio><bio xml:lang="en"><p>Anastasia E. Vorobyova</p><p>2/1/1 Barrikadnaya St., Moscow 125993</p></bio><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru">Федеральное государственное бюджетное образовательное учреждение дополнительного профессионального образования «Российская медицинская академия непрерывного профессионального образования» Министерства здравоохранения Российской Федерации<country>Россия</country></aff><aff xml:lang="en">Russian Medical Academy of Continuous Professional Education<country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru">Федеральное государственное бюджетное учреждение дополнительного профессионального образования «Центральная государственная медицинская академия» Управления делами Президента Российской Федерации; Государственное бюджетное учреждение здравоохранения города Москвы «Госпиталь для ветеранов войн № 2 Департамента здравоохранения города Москвы»<country>Россия</country></aff><aff xml:lang="en">Central State Medical Academy of the Department of Presidential Affairs; Hospital for War Veterans No. 2<country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru">Федеральное государственное бюджетное учреждение «Государственный научный центр Российской Федерации — Федеральный медицинский биофизический центр имени А.И. Бурназяна»<country>Россия</country></aff><aff xml:lang="en">State Research Center — Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency<country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2024</year></pub-date><pub-date pub-type="epub"><day>30</day><month>05</month><year>2024</year></pub-date><volume>12</volume><issue>3</issue><fpage>253</fpage><lpage>267</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Сычев Д.А., Черняева М.С., Рожкова М.А., Воробьева А.Е., 2024</copyright-statement><copyright-year>2024</copyright-year><copyright-holder xml:lang="ru">Сычев Д.А., Черняева М.С., Рожкова М.А., Воробьева А.Е.</copyright-holder><copyright-holder xml:lang="en">Sychev D.A., Cherniaeva M.S., Rozhkova M.A., Vorobyova A.E.</copyright-holder><license license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.risksafety.ru/jour/article/view/420">https://www.risksafety.ru/jour/article/view/420</self-uri><abstract><sec><title>ВВЕДЕНИЕ</title><p>ВВЕДЕНИЕ. Фармакотерапия пациентов пожилого и старческого возраста сопряжена с полиморбидностью, полипрагмазией и, как следствие, может привести к возникновению нежелательных реакций (НР). Внедрение в клиническую практику критериев Бирса — ключевых рекомендаций по оптимизации назначений лекарственных средств (ЛС) в гериатрической популяции — приобретает все большую актуальность в связи с увеличением во всем мире доли населения в возрасте 60 лет и старше.</p></sec><sec><title>ЦЕЛЬ</title><p>ЦЕЛЬ. Обзор истории создания критериев Бирса, основных изменений в обновленной версии в 2023 г., а также опыта использования критериев Бирса в практическом здравоохранении по данным российской и зарубежной литературы.</p></sec><sec><title>ОБСУЖДЕНИЕ</title><p>ОБСУЖДЕНИЕ. Критерии оценки рациональности фармакотерапии у пациентов пожилого и старческого возраста, предложенные М. Бирсом в 1991 г., регулярно пересматриваются и обновляются группой экспертов Американского гериатрического общества (American Geriatrics Society). С 2023 г. действует 7-я версия рекомендаций, предназначенных для поддержки принятия решений о лекарственной терапии у пациентов 65 лет и старше во всех амбулаторных, неотложных и стационарных условиях оказания медицинской помощи, за исключением хосписов и учреждений ухода. В обновленной версии критерии распределены на 5 категорий: 1) ЛС, применения которых следует избегать; 2) ЛС, применение которых потенциально нежелательно при определенных заболеваниях или синдромах; 3) ЛС, которые следует применять с осторожностью; 4) ЛС, применение которых потенциально нежелательно в связи с риском возникновения клинически значимых межлекарственных взаимодействий; 5) ЛС, применения которых следует избегать или снижать дозировку при нарушении функции почек. В отдельную группу обобщены ЛС с выраженным антихолинергическим действием. Критерии опираются на разработанную экспертами градацию качества доказательств и силы рекомендаций. Наиболее значимые изменения в обновленной версии критериев Бирса (2023 г.) по сравнению с предыдущей версией (2019 г.) коснулись рекомендаций в отношении ЛС групп антикоагулянтов и сульфонилмочевины. Результаты проведенного анализа показали, что критерии Бирса активно используются в практическом здравоохранении в Российской Федерации и за рубежом с целью снижения нежелательного воздействия потенциально не рекомендованных ЛС на пожилых пациентов за счет оптимизации выбора ЛС и схемы лечения, для обучения врачей и пациентов принципам рациональной фармакотерапии, а также для снижения стоимости фармакотерапии и оценки качества оказания медицинской помощи.</p></sec><sec><title>ВЫВОДЫ</title><p>ВЫВОДЫ. Критерии Бирса являются эффективным инструментом для выявления потенциально не рекомендованных ЛС в уже назначенной лекарственной терапии и для подбора наиболее подходящего нового варианта. Применение критериев Бирса в практическом здравоохранении позволяет уменьшить количество НР, снизить частоту госпитализаций и уровень смертности у пациентов пожилого и старческого возраста.</p></sec></abstract><trans-abstract xml:lang="en"><sec><title>INTRODUCTION</title><p>INTRODUCTION. Pharmacotherapy in elderly and senile patients is associated with multimorbidity and polypharmacy and can lead to adverse drug reactions (ADRs). The growth of the world’s population over 60 makes the practical application of the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, the key recommendations to optimise prescribing in the geriatric population, increasingly important.</p></sec><sec><title>AIM</title><p>AIM. This study aimed to review the history of the Beers criteria, the main changes in the updated 2023 version, and national and international publications on the practical experience of using the criteria in healthcare settings.</p></sec><sec><title>DISCUSSION</title><p>DISCUSSION. The criteria for assessing the rationality of pharmacotherapy in older patients were developed by Mark Beers in 1991. His recommendations have been regularly reviewed and updated by a panel of experts from the American Geriatrics Society (AGS); version 7 has been in effect since 2023. The criteria are designed to support pharmacotherapy decision making for adults 65 years old and older in all ambulatory, acute, and institutionalised settings of care, except hospice and end-of-life care settings. The criteria are organised into 5 categories: 1) medications that should be avoided in all older adults; 2) medications considered potentially inappropriate in patients with certain diseases or syndromes; 3) medications that should be used with caution; 4) medications that are potentially inappropriate due to the risk of clinically significant drug–drug interactions; 5) medications that should be avoided or require dosage reduction in patients with impaired renal function. Medicines with pronounced anticholinergic effects are categorised as a separate class. The criteria are based on expert grading of the quality of evidence and strength of recommendations. Compared with the previous version (2019), the updated AGS Beers Criteria® (2023) changed the most in terms of recommendations for anticoagulants and sulfonylureas. According to the results of this review, the AGS Beers Criteria® are actively used in healthcare practice in Russia and abroad to reduce the undesirable effects of potentially inappropriate medication use in elderly patients by optimising the selection of medicines and treatment regimens; to train healthcare providers and patients in the principles of rational pharmacotherapy; to reduce the cost of pharmacotherapy; and to assess the quality of medical care.</p></sec><sec><title>CONCLUSIONS</title><p>CONCLUSIONS. The AGS Beers Criteria® are an effective tool for identifying potentially inappropriate medications in prescribed therapy and selecting appropriate alternatives. Their practical application in healthcare settings can reduce ADRs, hospital admissions, and mortality rates in elderly and senile patients.</p></sec></trans-abstract><kwd-group xml:lang="ru"><kwd>потенциально не рекомендованные лекарственные средства</kwd><kwd>критерии Бирса</kwd><kwd>пожилые пациенты</kwd><kwd>пациенты старческого возраста</kwd><kwd>нежелательные реакции</kwd><kwd>фармакотерапия пожилого пациента</kwd><kwd>полипрагмазия</kwd><kwd>полиморбидность</kwd><kwd>безопасность фармакотерапии</kwd><kwd>межлекарственное взаимодействие</kwd></kwd-group><kwd-group xml:lang="en"><kwd>potentially inappropriate medications</kwd><kwd>PIMs</kwd><kwd>Beers criteria</kwd><kwd>older adults</kwd><kwd>elderly</kwd><kwd>senile</kwd><kwd>adverse drug reactions</kwd><kwd>ADRs</kwd><kwd>pharmacotherapy in older adults</kwd><kwd>polypharmacy</kwd><kwd>multimorbidity</kwd><kwd>safety of pharmacotherapy</kwd><kwd>drug–drug interactions</kwd></kwd-group><funding-group xml:lang="ru"><funding-statement>Работа выполнена без спонсорской поддержки.</funding-statement></funding-group><funding-group xml:lang="en"><funding-statement>The study was performed without external funding.</funding-statement></funding-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Onder G, Petrovic M, Tangiisuran B, Meinardi MC, Markito-Notenboom Winih P, Somers A, et al. 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