Potentially Inappropriate Medication Use in Older Outpatients From Geriatric Departments in China

To evaluate and compare the prevalence, agreement, and associated risk factors of potentially inappropriate medications (PIMs) using 8 explicit screening criteria among Chinese older outpatients.

A large-scale, multicenter cross-sectional study was conducted using prescription data from 59 health care institutions (comprising 48 tertiary and 11 secondary hospitals) across 6 cities in China. The sampled data set encompassed all eligible prescriptions from various subspecialties within the geriatric outpatient departments, including the geriatric cadre, comprehensive geriatric, geriatric respiratory, and geriatric cardiovascular clinics. The study included 130,243 prescriptions for outpatients aged 65 years and older.

Among the 130,243 prescriptions analyzed (median patient age, 76 [interquartile range, 70-85] years; 78,784 [60.49%] male), 18.1% involved polypharmacy (≥5 medications), and 18.0% of patients had 5 or more chronic diseases. The most common morbidities were cardiovascular diseases (46.4%), endocrine and metabolic diseases (18.2%), and mental disorders (15.7%). The prevalence of PIMs varied significantly across criteria, ranging from 13.33% (Screening Tool of Older Persons' Prescriptions 2023) to 36.48% (PIM-China 2024). Overall agreement among the 8 criteria was moderate (κ = 0.477). Psychiatric medications and nonsteroidal anti-inflammatory drugs were the primary drivers of PIMs. Multivariable analysis identified polypharmacy as the strongest predictor of PIM exposure (adjusted odds ratio, 3.40-5.58), followed by comorbid psychiatric disorders (adjusted odds ratio, up to 13.43) and advanced age (patients with PIM exposure were significantly older across all criteria).

The updated PIM-China 2024 criteria demonstrated the highest sensitivity for identifying medication risks in this population. Clinical deprescribing interventions and medication safety management should prioritize the oldest-old population, particularly those with polypharmacy and psychiatric comorbidities.