Potentially inappropriate medication use among elderly Chinese outpatients in neurology clinics: a cross-sectional study comparing the beers criteria and the Chinese criteria

Older neurology outpatients may be at higher risk of potentially inappropriate medications (PIMs) due to multimorbidity and frequent use of central nervous system (CNS)-active drugs. This study assessed the prevalence of PIMs and the factors associated with PIM use among elderly neurology outpatients in China. A retrospective cross-sectional study was conducted using outpatient prescription data from older outpatients attending the neurology clinic of a tertiary hospital in China between January 1 and September 30, 2025. PIMs were evaluated in parallel using the 2023 American Geriatrics Society (AGS) Beers criteria and the 2017 Chinese PIM criteria. Multivariable logistic regression was performed to identify factors associated with PIM use, and concordance between the two criteria was assessed. A total of 5150 neurology outpatients were included. The prevalence of PIM was 44.31% according to the Beers criteria and 42.23% according to the Chinese criteria. Benzodiazepine receptor agonist hypnotics, antipsychotics, and ergoloid mesylates were the most frequently identified PIM categories under both criteria. Zolpidem was the most frequently identified PIM under the Beers criteria, whereas clopidogrel ranked first under the Chinese criteria. Multivariable logistic regression analysis showed that polypharmacy, sleep disorders, and mental disorders were consistently the factors positively associated with PIM use under both criteria, whereas, atrial fibrillation and ischemic stroke showed criterion-dependent differences in their associations with PIMs. Sensitivity analyses demonstrated that these criterion-dependent differences were attributable to the divergent medication lists of the two criteria. The findings indicate a worrying prevalence of PIMs among elderly patients in neurology clinics in China. Particular attention should be paid to elderly patients prescribed benzodiazepine receptor agonist hypnotics, antipsychotics, or ergoloid mesylates, or those with risk factors such as polypharmacy, sleep disorders, and mental disorders. This study was registered at Chinese Clinical Trail Registry (Registration Number: ChiCTR2500114900).