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Background <p>Older adults with psychiatric conditions are at elevated risk for potentially inappropriate medication (PIM) use due to multimorbidity, polypharmacy, and cognitive vulnerability. PIMs increase the risk of adverse drug reactions (ADRs), especially in low-resource settings where clinical pharmacy support may be limited.</p> Objective <p>The aim of this study was to determine the prevalence, types, and predictors of PIM use among older psychiatric outpatients using the 2023 American Geriatrics Society (AGS) Beers criteria.</p> Methods <p>This cross-sectional study was conducted at the psychiatry outpatient department of a tertiary care hospital in India from December 2021 to March 2023. Older adults patients (aged ≥65 years) prescribed at least one psychotropic medication were assessed for PIM use based on the Beers criteria. Demographic, clinical, and prescription data were analyzed, and logistic regression was used to identify predictors of PIM use.</p> Results <p>Among 364 patients (median age 69 years), the prevalence of PIM use was 88.7%. A total of 692 PIM instances were identified, with benzodiazepines (22.1%), selective serotonin reuptake inhibitors (SSRIs, 20.2%), and antipsychotics (13.6%) being most common. Polypharmacy (≥5 drugs) was present in 32.15% of patients. Anticholinergic burden (ACB) score ≥3 (adjusted odds ratio [AOR] 3.55, 95% CI 1.12–11.31; <i>p</i>&#xa0;=&#xa0;0.032) and potential drug–drug interactions (AOR 3.73, 95% CI 1.16–12.03; <i>p</i>&#xa0;=&#xa0;0.028) were significantly associated with PIM use. Although ADRs (e.g., sedation, hyponatremia) were more frequent in those with PIMs, their association did not reach statistical significance (AOR 7.08; <i>p</i>&#xa0;=&#xa0;0.071).</p> Conclusion <p>PIM use is highly prevalent among older adults attending a tertiary care psychiatric clinic, with benzodiazepines, SSRIs, and antipsychotics being the most frequently prescribed. A high anticholinergic burden and potential drug–drug interactions were significant predictors of PIM use, whereas polypharmacy was not independently associated in multivariate analysis. Targeted interventions, including medication review and deprescribing strategies, are essential to enhance prescribing safety and reduce adverse drug-related outcomes.</p>

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Prevalence and Predictors of Potentially Inappropriate Medication Use in Older Outpatients: A Cross-Sectional Study Using the 2023 Beers Criteria at a Tertiary Care Clinic

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月13日

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  • Manjunath Bidarolli,
  • Biswadeep Das,
  • Vikram Singh Rawat,
  • Mahima Gupta,
  • Hannah Theresa Sony,
  • Akash Agnihotri

摘要

Background

Older adults with psychiatric conditions are at elevated risk for potentially inappropriate medication (PIM) use due to multimorbidity, polypharmacy, and cognitive vulnerability. PIMs increase the risk of adverse drug reactions (ADRs), especially in low-resource settings where clinical pharmacy support may be limited.

Objective

The aim of this study was to determine the prevalence, types, and predictors of PIM use among older psychiatric outpatients using the 2023 American Geriatrics Society (AGS) Beers criteria.

Methods

This cross-sectional study was conducted at the psychiatry outpatient department of a tertiary care hospital in India from December 2021 to March 2023. Older adults patients (aged ≥65 years) prescribed at least one psychotropic medication were assessed for PIM use based on the Beers criteria. Demographic, clinical, and prescription data were analyzed, and logistic regression was used to identify predictors of PIM use.

Results

Among 364 patients (median age 69 years), the prevalence of PIM use was 88.7%. A total of 692 PIM instances were identified, with benzodiazepines (22.1%), selective serotonin reuptake inhibitors (SSRIs, 20.2%), and antipsychotics (13.6%) being most common. Polypharmacy (≥5 drugs) was present in 32.15% of patients. Anticholinergic burden (ACB) score ≥3 (adjusted odds ratio [AOR] 3.55, 95% CI 1.12–11.31; p = 0.032) and potential drug–drug interactions (AOR 3.73, 95% CI 1.16–12.03; p = 0.028) were significantly associated with PIM use. Although ADRs (e.g., sedation, hyponatremia) were more frequent in those with PIMs, their association did not reach statistical significance (AOR 7.08; p = 0.071).

Conclusion

PIM use is highly prevalent among older adults attending a tertiary care psychiatric clinic, with benzodiazepines, SSRIs, and antipsychotics being the most frequently prescribed. A high anticholinergic burden and potential drug–drug interactions were significant predictors of PIM use, whereas polypharmacy was not independently associated in multivariate analysis. Targeted interventions, including medication review and deprescribing strategies, are essential to enhance prescribing safety and reduce adverse drug-related outcomes.