Potentially Inappropriate Prescribing in the Elderly: Observations from an Eastern Indian Setup

Background: The use of potentially inappropriate medications (PIMs) poses a significant challenge in prescribing for geriatric patients. With the global elderly population steadily rising, the prevalence of comorbidities and polypharmacy further amplifies the risks associated with PIM, including increased morbidity, hospitalizations, and adverse drug reactions. This study was therefore undertaken to assess the prevalence and patterns of PIM use among elderly patients. Methods: A cross-sectional and observational study was conducted over 6 months, involving geriatric outpatients and inpatients at a tertiary care facility. Their prescriptions were meticulously reviewed for PIM based on the Beers Criteria 2023 and the screening tool to alert to right treatment/screening tool of older persons’ prescriptions (STOPP) criteria. The key demographic information and functional performance, assessed using the Barthel Index, were also documented. Results: The study included 200 geriatric patients, with a slight male predominance (53.5%). Among the various comorbidities observed, osteoarthritis was the most prevalent, followed by hypertension and dyslipidemia. The majority of patients were functionally independent. Analysis using the Beers Criteria 2023 revealed a PIM prevalence of 35.5%, with 9.5% of patients having two or more PIMs. Disease-specific PIMs were identified in 17% ( n = 34) of cases, while 4% ( n = 8) involved medications requiring cautious use. In addition, 2% ( n = 4) of cases featured potentially clinically significant drug–drug interactions that should be avoided in older adults. In 2.5% ( n = 5) of cases, medications were prescribed that should either be avoided or have dosage adjustments based on kidney function. According to the STOPP criteria, 14.5% ( n = 29) of prescriptions were identified as PIMs. Conclusion: Given the notable prevalence of PIM, clinicians must exercise heightened caution when prescribing for elderly patients. In certain cases, seeking guidance from clinical pharmacologists may be beneficial to ensure optimal medication selection and patient safety.