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Interventions to Address Potentially Inappropriate Prescribing for Older Primary Care Patients: A Systematic Review
Nav Persaud1,2,3, Aine Workentin1, Amal Rizvi1
1MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.
JAMA Network Open
|June 27, 2025
Summary
Interventions for potentially inappropriate prescribing in older adults reduced medication numbers by about 0.5 per patient. However, these interventions did not significantly impact drug harms, hospitalizations, or mortality in primary care settings.
Area of Science:
- Geriatric Medicine
- Pharmacology
- Evidence-Based Medicine
Background:
- Potentially inappropriate medication (PIM) prescriptions are prevalent in older adults, carrying risks that may outweigh their benefits.
- Addressing PIMs is crucial for improving health outcomes and reducing healthcare burdens in the elderly population.
Purpose of the Study:
- To evaluate the impact of interventions targeting potentially inappropriate prescribing in older primary care patients.
- To determine associations with changes in medication count, drug-related harms, hospitalizations, and mortality.
Main Methods:
- A systematic review and meta-analysis of randomized clinical trials (RCTs) was conducted.
- Searches included MEDLINE, Embase, and Cochrane Central Register of Controlled Trials up to September 2024.
- Data from 118 RCTs involving 417,412 patients were synthesized using random-effects models.
Main Results:
- Interventions were associated with a significant reduction in the number of medications prescribed (SMD, -0.25), averaging 0.5 fewer medications per patient.
- No substantial differences were observed in nonserious adverse drug reactions, injurious falls, quality of life, medical visits, emergency department admissions, hospitalizations, or all-cause mortality.
Conclusions:
- Interventions to reduce potentially inappropriate prescribing in older adults can safely decrease medication burden.
- Further research with standardized criteria is recommended to consistently report harms and capture key outcomes like quality of life and mortality.
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