Mapping the Prevalence and Most Common Types of Potentially Inappropriate Medications (PIMs) in Older Adults with Polypharmacy: A Decade-Long Scoping Review in Nursing Home Settings
DOI:
https://doi.org/10.35473/ijpnp.v8i02.4340Keywords:
nursing homes, polypharmacy, PIM, elderlyAbstract
Polypharmacy among older adults significantly influences the prevalence of potentially inappropriate medication (PIMs). Most existing studies have focused on community-dwelling older adults and primary health care settings. However, a comprehensive overview of the use of PIMs among older adults in nursing homes is still lacking. This study aimed to map the scientific evidence regarding the prevalence and most commonly reported PIMs in nursing homes. This scoping review was conducted based on a literature search of four electronic databases on July 29, 2025. We included observational studies published in English that reported the prevalence and types of PIMs in older adults residing in nursing homes. A total of 1,030 records were identified, and 13 studies fulfilled the inclusion criteria. The prevalence of PIM among older adults in nursing homes varied widely, ranging from 27.2% to 96.3%. Benzodiazepines and proton pump inhibitors were the most frequently reported PIMs. All the included studies were conducted in middle- and high-income countries. Future research should address the geographical evidence gap by conducting studies in underrepresented regions, particularly in low- and middle-income countries, to improve the generalizability of the findings.
References
Allegri, N., Rossi, F., Del Signore, F., Bertazzoni, P., Bellazzi, R., Sandrini, G., Vecchi, T., Liccione, D., Pascale, A., & Govoni, S. (2017). Drug prescription appropriateness in the elderly: an Italian study. Clinical Interventions in Aging, Volume 12, 325–333. https://doi.org/10.2147/CIA.S109125
Alves-Conceição, V., Silva, D. T. da, Santana, V. L. de, Santos, E. G. dos, Santos, L. M. C., & Lyra, D. P. de. (2017). Evaluation of pharmacotherapy complexity in residents of long-term care facilities: a cross-sectional descriptive study. BMC Pharmacology and Toxicology, 18(1), 59. https://doi.org/10.1186/s40360-017-0164-3
American Geriatrics Society. (2023). American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 71(7), 2052–2081. https://doi.org/10.1111/jgs.18372
Anrys, P. M. S., Strauven, G. C., Foulon, V., Degryse, J.-M., Henrard, S., & Spinewine, A. (2018). Potentially Inappropriate Prescribing in Belgian Nursing Homes: Prevalence and Associated Factors. Journal of the American Medical Directors Association, 19(10), 884–890. https://doi.org/10.1016/j.jamda.2018.06.010
Atmaja, D. S., Yulistiani, Y., Suharjono, S., & Zairina, E. (2024). Implementation of a pharmacovigilance system to detect adverse events and improve medication appropriateness in a hospital in Indonesia. Pharmacy Education, 24(3), 7–11. https://doi.org/10.46542/pe.2024.243.711
Burato, S., Leonardi, L., Antonazzo, I. C., Raschi, E., Ajolfi, C., Baraghini, M., Chiarello, A., Delmonte, V., Di Castri, L., Donati, M., Fadda, A., Fedele, D., Ferretti, A., Gabrielli, L., Gobbi, S., Lughi, S., Mazzari, M., Pieraccini, F., Renzetti, A., … Poluzzi, E. (2021). Comparing the Prevalence of Polypharmacy and Potential Drug-Drug Interactions in Nursing Homes and in the Community Dwelling Elderly of Emilia Romagna Region. Frontiers in Pharmacology, 11. https://doi.org/10.3389/fphar.2020.624888
Caçador, C., Teixeira-Lemos, E., Oliveira, J., Pinheiro, J., Teixeira-Lemos, L., & Ramos, F. (2022). The Prevalence of Polypharmacy and Potentially Inappropriate Medications and Its Relationship with Cognitive Status in Portuguese Institutionalized Older Adults: A Cross-Sectional Study. International Journal of Environmental Research and Public Health, 19(5), 2637. https://doi.org/10.3390/ijerph19052637
Chae, H.-W., Zhao, J., Ah, Y.-M., Choi, K. H., & Lee, J.-Y. (2023). Potentially inappropriate medication use as predictors of hospitalization for residents in nursing home. BMC Geriatrics, 23(1), 467. https://doi.org/10.1186/s12877-023-04165-w
Chen, Q.-F., Ni, C., Jiang, Y., Chen, L., Liao, H., Gao, J., Qin, X., Pan, S., Luan, X., Wu, Y., Zhou, X.-D., & Song, W. (2025). Global burden of disease and its risk factors for adults aged 70 and older across 204 countries and territories: a comprehensive analysis of the Global Burden of Disease Study 2021. BMC Geriatrics, 25(1), 462. https://doi.org/10.1186/s12877-025-06095-1
Condur, L. M., Chirila, S. I., Alexandrescu, L., Iancu, M. A., Neculau, A. E., Berariu, F. V., Toma, L., & Nicoara, A. D. (2025). Proton Pump Inhibitor Use in Older Adult Patients with Multiple Chronic Conditions: Clinical Risks and Best Practices. Journal of Clinical Medicine, 14(15), 5318. https://doi.org/10.3390/jcm14155318
Díez, R., Cadenas, R., Susperregui, J., Sahagún, A. M., Fernández, N., García, J. J., Sierra, M., & López, C. (2022). Potentially Inappropriate Medication and Polypharmacy in Nursing Home Residents: A Cross-Sectional Study. Journal of Clinical Medicine, 11(13), 3808. https://doi.org/10.3390/jcm11133808
Drusch, S., Le Tri, T., Ankri, J., Michelon, H., Zureik, M., & Herr, M. (2023). Potentially inappropriate medications in nursing homes and the community older adults using the French health insurance databases. Pharmacoepidemiology and Drug Safety, 32(4), 475–485. https://doi.org/10.1002/pds.5575
Hanlon, J. T., Aspinall, S. L., Handler, S. M., Gellad, W. F., Stone, R. A., Semla, T. P., Pugh, M. J. V., & Dysken, M. W. (2015). Potentially Suboptimal Prescribing for Older Veteran Nursing Home Patients With Dementia. Annals of Pharmacotherapy, 49(1), 20–28. https://doi.org/10.1177/1060028014558484
Heiks, C., & Sabine, N. (2022). Long Term Care and Skilled Nursing Facilities. Delaware Journal of Public Health, 8(5), 144–149. https://doi.org/10.32481/djph.2022.12.032
Henschel, F., Redaelli, M., Siegel, M., & Stock, S. (2015). Correlation of Incident Potentially Inappropriate Medication Prescriptions and Hospitalization: An Analysis Based on the PRISCUS List. Drugs - Real World Outcomes, 2(3), 249–259. https://doi.org/10.1007/s40801-015-0035-4
Herr, M., Grondin, H., Sanchez, S., Armaingaud, D., Blochet, C., Vial, A., Denormandie, P., & Ankri, J. (2017). Polypharmacy and potentially inappropriate medications: a cross-sectional analysis among 451 nursing homes in France. European Journal of Clinical Pharmacology, 73(5), 601–608. https://doi.org/10.1007/s00228-016-2193-z
Jankyova, S., Rubintova, D., & Foltanova, T. (2020). The analysis of the use of potentially inappropriate medications in elderly in the Slovak Republic. International Journal of Clinical Pharmacy, 42(1), 100–109. https://doi.org/10.1007/s11096-019-00944-x
Jenghua, K., Phatthanasobhon, S., & Poolpun, D. (2025). Prevalence, determinants, and health outcomes of potentially inappropriate medication use according to the 2023 Beers criteria among hospitalised older patients. Archives of Gerontology and Geriatrics, 129, 105693. https://doi.org/10.1016/j.archger.2024.105693
Junius-Walker, U., Krause, O., Thürmann, P., Bernhard, S., Fuchs, A., Sparenberg, L., Wollny, A., Stolz, R., Haumann, H., Freytag, A., Kirsch, C., Usacheva, S., Wilm, S., & Wiese, B. (2021). Drug Safety for Nursing-Home Residents. Deutsches Ärzteblatt International, 118(42), 705–712. https://doi.org/10.3238/arztebl.m2021.0297
