OBJECTIVE: Potentially inappropriate prescribing for the elderly (PIPE) is an important patient safety concern. Previous studies indicate that over 20% of community-dwelling elderly experience PIPE. However, data limitations precluded identifying appropriate use of dose-dependent drugs and drugs identified as having appropriate indications by an expert consensus panel. Thus, we used data from the Department of Veterans Affairs (VA) to assess these previously unexamined features of PIPE, and identify those most likely to experience PIPE. METHODS: We merged demographic and diagnostic data from national inpatient and outpatient files and national pharmacy data for veterans > 65 years (FY00), and identified those receiving potentially inappropriate drugs. Those who received diagnoses for indications deemed appropriate by an Agency for Health care Research and Quality expert panel, and those receiving doses at or below geriatric doses were identified as receiving these drugs appropriately. We then used logistic regression to identify patient (e.g. age, sex, race) and provider factors (e.g. received geriatric specialty care) associated with PIPE. RESULTS: Adjusting for diagnostic and drug dose information, 20.52% of older veterans received a potentially inappropriate drug. Women and younger individuals (65-84 years vs. > 85 years) were more likely to experience PIPE (OR 1.30; 95% CI's 1.24-1.32, 1.28-1.35 respectively). Those who received specialty geriatric care were less likely to experience PIPE (OR 0.78; 95% CI 0.76-0.80). CONCLUSIONS: A substantial number of older veterans receive potentially inappropriate drugs despite adjusting for dose and diagnosis. Thus, a large number of older veterans are at increased risk for injury, hospitalization, and death. Research is needed to identify barriers to reducing PIPE and develop interventions to decrease PIPE. However, this study suggests that, despite greater disease burden, older patients receiving specialized geriatric care are at lower risk of PIPE. Thus, increasing access to specialty geriatric care may be an important place to start.