OBJECTIVES: To establish explicit criteria for potentially inappropriate medication prescribing (PIP) for the elderly and assess the prevalence of and factors associated with PIP among elderly residents in the Local Health Unit (LHU) of Parma, Italy according to the developed criteria. METHODS: A nine-member expert panel was convened to develop a list of inappropriate medications reflecting the Italian prescribing habits. Using the 2002 Beers criteria as a framework, consensus through a two-round Delphi method was reached to classify the identified 23 inappropriate medications into three categories: 17 medications to be always avoided, 3 medications rarely appropriate, and 3 medications with some indications but often misused. A retrospective cohort study using the 2006 Parma LHU automated outpatient prescriptions database was conducted. The cohort comprised 91,741 individuals ≥65 years with at least 1 prescription medication. PIP was defined as having a prescription claim for at least one inappropriate medication. RESULTS: A total of 23,662 elderly in the cohort (25.8%) had at least one PIP. Of these, 14.1% received prescriptions for 2 medications of concern, and 2.0% for 3 or more. Using the expert panel's categories, 59.2% of the elderly receiving PIP had prescriptions for drugs that should always be avoided, 33.9% for rarely appropriate drugs, and 19.1% for drugs that have some indications but are often misused. NSAIDs (35.7% of subjects) were the most frequently occurring PIP, followed by ticlopidine (17.6%), doxazosin (15.5%) and amiodarone (13.6%). Female, older age, overall number of drugs prescribed, greater number of chronic conditions were factors associated with greater odds of receiving PIP. CONCLUSIONS Via the developed criteria, the study corroborates that PIP among elderly outpatients is a substantial issue in Parma LHU, Italy. Knowledge of the prevalence of PIP and associated factors should gear efforts to develop strategies to reduce PIP in outpatient settings in Italy.