Explicit criteria for potentially inappropriate medications in older adults: A comprehensive systematic review

Context: Potentially inappropriate medications (PIMs) refer to the use of a medication whose risks outweigh the potential benefits in older adults, especially when other effective alternatives are available. Aims: To identify and analyze explicit criteria developed for detecting PIMs in older adults, highlighting methodological approaches and pharmacological classifications. Methods: A comprehensive literature search was conducted across seven databases from January 1990 to December 2024, following the PRISMA 2020 guidelines. Criteria developed using expert consensus or evidence-based processes were included. Results: Out of 3,119 articles, 68 met the inclusion criteria. The Beers and STOPP/START tools were most frequently cited. The Delphi method was the predominant approach for validating the selected tools (73.53%). Commonly flagged medications included tricyclic antidepressants, NSAIDs, and benzodiazepines. Conclusions: Numerous validated tools exist, although variations in validation methods and drug classification were observed. A global update and harmonization of explicit criteria are necessary for improved geriatric pharmacotherapy.