PREVALENCE, RISK FACTORS, AND SAFETY IMPLICATIONS OF POTENTIALLY INAPPROPRIATE MEDICATION USE AMONG OLDER ADULTS WITH DEMENTIA: A SYSTEMATIC REVIEW
Author(s)
Samuel C. Ofili, BPharm1, Jannah Abdulmawjood, BSc2, Bilqees Fatima, Pharm.D, MS, PhD1, Isaiah Olumeko, PharmD, MPH1, Sai S. Cheruvu, MPH1, Jeff Sherer, Pharm.D., MPH, B.C.P.S, C.G.P3, Rajender R. Aparasu, BPharm, MPharm, PhD1, Susan Abughosh, PhD1;
1University of Houston, Pharmaceutical Outcomes and Policy, Houston, TX, USA, 2University of Houston, Pharmacy, Houston, TX, USA, 3University of Houston, Pharmacy Practice and Translational Research, Houston, TX, USA
1University of Houston, Pharmaceutical Outcomes and Policy, Houston, TX, USA, 2University of Houston, Pharmacy, Houston, TX, USA, 3University of Houston, Pharmacy Practice and Translational Research, Houston, TX, USA
OBJECTIVES: Older adults with dementia often have multiple comorbidities, resulting in the use of multiple medications. Polypharmacy is a significant risk factor for potentially inappropriate medication (PIM), and PIMs are strongly associated with significant adverse drug events (ADRs), including mortality. This systematic review evaluates the prevalence of PIMs and frequently reported PIM classes from 2020-2025 among patients with dementia and examines the associated risks of PIM use.
METHODS: This systematic review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. PubMed and EMBASE were searched for English-language observational studies published between January 2020 and June 2025. Eligible studies assessed PIM use in individuals with dementia and reported prevalence, use patterns, or clinical implications. Data on study characteristics, Criteria used to identify PIM (e.g., Beers Criteria, Screening Tool of Older Persons’ Prescriptions [STOPP]), prevalence, medication types, and outcomes were independently extracted and synthesized.
RESULTS: The literature search identified 852 articles, of which eighteen studies met the inclusion criteria. Reported PIM prevalence ranged from 32.7% in community-dwelling cohorts to over 80% in acutely admitted Australian aged care residents. Central nervous system-acting drugs (antipsychotics, benzodiazepines, anticholinergics) were consistently identified as major PIM classes, alongside proton pump inhibitors, antidepressants, and nonsteroidal anti-inflammatory drugs. PIM use was largely driven by polypharmacy related to comorbidity management, with higher odds observed among female patients. PIMs were strongly associated with adverse events, hospitalizations, functional decline, and increased mortality.
CONCLUSIONS: PIM use is highly prevalent and associated with adverse outcomes in patients with dementia. Effective management requires multi-pronged strategies involving providers and caregivers to reduce PIM-related harm and improve medication safety in this vulnerable population.
METHODS: This systematic review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. PubMed and EMBASE were searched for English-language observational studies published between January 2020 and June 2025. Eligible studies assessed PIM use in individuals with dementia and reported prevalence, use patterns, or clinical implications. Data on study characteristics, Criteria used to identify PIM (e.g., Beers Criteria, Screening Tool of Older Persons’ Prescriptions [STOPP]), prevalence, medication types, and outcomes were independently extracted and synthesized.
RESULTS: The literature search identified 852 articles, of which eighteen studies met the inclusion criteria. Reported PIM prevalence ranged from 32.7% in community-dwelling cohorts to over 80% in acutely admitted Australian aged care residents. Central nervous system-acting drugs (antipsychotics, benzodiazepines, anticholinergics) were consistently identified as major PIM classes, alongside proton pump inhibitors, antidepressants, and nonsteroidal anti-inflammatory drugs. PIM use was largely driven by polypharmacy related to comorbidity management, with higher odds observed among female patients. PIMs were strongly associated with adverse events, hospitalizations, functional decline, and increased mortality.
CONCLUSIONS: PIM use is highly prevalent and associated with adverse outcomes in patients with dementia. Effective management requires multi-pronged strategies involving providers and caregivers to reduce PIM-related harm and improve medication safety in this vulnerable population.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EPH66
Topic
Epidemiology & Public Health
Topic Subcategory
Public Health, Safety & Pharmacoepidemiology
Disease
SDC: Geriatrics, SDC: Neurological Disorders