Inappropriate Prescription of Medicines

Inappropriate prescribing (IP) is a common problem in older people who experience multimorbidity and associated polypharmacy. In broad terms, IP encompasses overuse, misuse and underuse of medications in individual patients for specific reasons. Potentially inappropriate medications (PIMs) represent potential prescribing errors of commission; conversely, potential prescribing omissions (PPOs) occur when medications that are indicated and likely beneficial in individual cases are not prescribed for irrational or ageist reasons. Detection of PIMs and PPOs is important in routine clinical practice since both PIMs and PPOs are strongly associated with adverse clinical events that compromise patient safety. Older people experience high prevalence of both PIMs and PPOs in various clinical settings. Polypharmacy (i.e. ≥5 daily long-term medications) is strongly associated with both PIMs and PPOs, such that patients experiencing polypharmacy and particularly hyperpolypharmacy (i.e. ≥10 daily long-term medications) should be carefully assessed for both PIMs and PPOs in the interests of avoiding iatrogenic injury and protecting patient safety. Various sets of validated explicit IP criteria are available for clinical use; the best known of which are Beers criteria and STOPP/START criteria. Application of IP criteria during routine medication review is recommended particularly at points of clinical care transition.