Potentially Inappropriate Medications Among Outpatient Elderly Buddhist Monks in Thailand: A Comparison of 2023 Beers Criteria, STOPP Criteria Version 3, and 2024 PIM-BHIKKHU Criteria

Buddhist monks, or Bhikkhus, constitute a unique population whose religious practices and cultural norms influence their healthcare and medication use, presenting challenges not adequately addressed by existing tools such as the 2023 Beers criteria and Screening Tool of Older Persons’ Prescriptions (STOPP) Criteria Version 3. This study evaluated the newly developed 2024 potentially inappropriate medications (PIM)-BHIKKHU criteria in identifying PIM among elderly Bhikkhus in Thailand. A retrospective cross-sectional review of 225 outpatient elderly Bhikkhus’ medical and prescribing records at the Priest Hospital revealed that the prevalence of PIM use was highest with the PIM-BHIKKHU criteria (87.56%), compared to the Beers criteria (60.00%) and STOPP criteria (45.33%). The PIM-BHIKKHU criteria identified more PIMs per prescription and addressed challenges such as complex administration methods, fasting schedules, and inconsistent dietary patterns, which are insufficiently considered in other tools. These findings highlight the limitations of existing criteria in culturally distinct populations and underscore the importance of tailored approaches. The PIM-BHIKKHU criteria provide a comprehensive framework that integrates religious and cultural contexts to optimize medication safety for elderly Bhikkhus. Future research should validate the criteria in broader settings and assess their impact on clinical outcomes, such as adverse drug reactions and hospitalizations.