Effectively identifying individuals exposed to drug underuse, overuse and potentially inappropriate medication (PIM) in older adults is essential for minimizing preventable drug-related harms. We analysed data from 54,296 individuals aged 60-74 years from the German National Cohort (NAKO). We assessed the frequency of PIM, untreated conditions (medication and vaccination underuse) and medications without indication (overuse) utilizing the Fit fOR The Aged (FORTA) list. Factors associated with PIM, medication overuse and underuse were identified by multivariable logistic regression models. The frequency of PIM, underuse and overuse of medications was 26.1%, 19.1% and 23.6%, respectively. In participants with available vaccination information, 90.6% and 62.7% did not have the recommended pneumococcal and annual influenza virus vaccinations, respectively. Parkinson's disease, arterial hypertension, epilepsy and depression were strongly associated with PIM use, with 16.2-, 4.5-, 4.3- and 2.1-fold increased odds, respectively. Osteoporosis, atrial fibrillation, Parkinson's disease and chronic obstructive pulmonary disease were identified as particularly strongly associated with underuse, with 9.5-, 6.1-, 2.6- and 2.0-fold increased odds, respectively. Depression and epilepsy were the most prominent factors associated with overuse (1.6- and 1.5-fold increased odds). PIM and medication overuse, as well as drug and vaccine underuse, are very common among older German individuals. Comprehensive medication reviews are needed to improve medication quality. This work identifies people with specific characteristics who would benefit the most and could be prioritized for medication reviews.

Impact of Self-Reported Patient-Provider Communication on the Use of High- and Low-Value Care Among U.S. Adults.

Polypharmacy (concurrent use of ≥ 5 medications) is common in patients with non-small cell lung cancer and increases the risk of potentially inappropriate medication use, particularly in those with advanced disease. Deprescribing may reduce medication-related harm; however, its implementation in oncology remains limited and is insufficiently informed by stakeholder perspectives. This study aimed to determine the prevalence of potentially inappropriate medications in patients with advanced non-small cell lung cancer and explore the attitudes and beliefs of patients, caregivers, and healthcare professionals regarding deprescribing to inform feasible implementation strategies for routine clinical practice. A retrospective analysis was conducted in a cohort of 817 patients with stage IV non-small cell lung cancer to identify potentially inappropriate medications using the OncoSTRIP checklist. Perspectives on deprescribing were collected using validated questionnaires: the revised Patients' Attitudes Toward Deprescribing (rPATD) for patients and caregivers and the Comprehensive Healthcare Providers' Opinions, Preferences, and Attitudes Toward Deprescribing (CHOPPED) for medical clinicians and pharmacists, which were completed by 37 patients, 15 caregivers, 24 medical clinicians (physicians and specialist nurses), and 24 pharmacists. Potentially inappropriate medications were algorithm-flagged in 793 of the 817 (97.1%) patients. Among these, 1,686 (40.8%) were confirmed by clinical evidence, while 2,448 (59.2%) were unconfirmed (defined as medications flagged by the checklist but lacking sufficient electronic health record data, such as laboratory values or specific indications, to definitively justify their use). The primary classifications were the risk of adverse drug events (47.3%) and unnecessary therapy (30.0%). Most patients (33, 89.2%) and caregivers (11, 73.3%) were willing to discontinue their medications if advised by a physician. Perceived barriers influenced medical clinicians' and pharmacists' willingness: medical clinicians were most affected by collaboration- and competence-related concerns, whereas pharmacists were constrained by competence- and patient-related factors. The high algorithm-flagged prevalence of potentially inappropriate medications with 40.8% confirmed by clinical evidence, in patients with advanced non-small cell lung cancer underscores the urgent need for deprescribing. Successful implementation requires a patient-centered approach, active involvement of patients and caregivers, interprofessional collaboration, and targeted strategies to address systemic and professional barriers to ensure safe and sustainable medication optimization.

ObjectiveTo analyze the prevalence of potentially inappropriate medication use in older adults and develop a nomogram for predicting the individualized risk for potentially inappropriate medication use.MethodsA retrospective cross-sectional study was conducted using prescription data from older adults who visited the Hefei Third People's Hospital between May 2022 and May 2024. The 2019 Beers Criteria and Chinese criteria for Determining Potentially Inappropriate Medication Use in Older Adults in China were used to identify potentially inappropriate medication use. We conducted univariate and multivariate logistic regression analyses to identify the factors associated with potentially inappropriate medication use and developed a nomogram model to predict the individualized risk of potentially inappropriate medication use.ResultsAmong the 475 older adults included, 195 (41.05%) had at least one incidence of potentially inappropriate medication use (total 288 occurrences). Medications considered as potentially inappropriate were most commonly used (88.72%), followed by medications to be used with caution (6.67%), potentially inappropriate drug-drug interactions (1.54%), and medications potentially inappropriate for patients with certain diseases or syndromes (2.05%). Benzodiazepines, rapid/short-acting insulin, proton pump inhibitors, and amitriptyline were the most frequently used potentially inappropriate medications. Independent risk factors for potentially inappropriate medication use included: (a) age ≥70 years; (b) diabetes mellitus; (c) hypertension; (d) coronary heart disease; (e) sleep disorders; (f) ≥3 comorbidities; and (g) use of ≥4 medications. The nomogram showed moderate discriminative ability (concordance index =0.738) with good calibration and minimal overfitting.ConclusionAdvanced age, multiple chronic conditions, and polypharmacy are key predictors of potentially inappropriate medication in older adults. Enhanced monitoring and personalized medication management may help reduce the risk of potentially inappropriate medication use in this population.

Evaluation of polypharmacy and potentially inappropriate medication use among geriatric individuals aged 80 years and older.

Objectives: Inappropriate medication use is highly prevalent in nursing home residents and contributes to adverse drug events, falls, and increased healthcare utilization. The Turkish Inappropriate Medication use in oldEr adults (TIME) criteria provide a comprehensive framework for identifying both potentially inappropriate medications and prescribing omissions. We aimed to evaluate the outcomes of a Medication Therapy Management (MTM) intervention by use of TIME criteria among nursing home residents in Türkiye. Methods: This single-arm before–after observational study included 232 adults aged 60–110 years residing in the Bursa Metropolitan Municipality Nursing Home. Medication use patterns were evaluated using the TIME criteria and prescriptions were optimized through a Medication Therapy Management (MTM) intervention. Fall frequency and healthcare utilization outcomes were recorded during the 1 year before and after MTM implementation. Results: Following implementation of the Medication Therapy Management (MTM) approach based on TIME criteria, the median number of medications increased from 5 (IQR: 3–8) to 8 (IQR: 5–10) over one year (p < 0.001). During the post-implementation period, fall frequency, emergency department visits, family medicine visits, and non-geriatric specialist visits were lower compared with the pre-intervention year, whereas hospitalization rates did not significantly change. Conclusions: Among nursing home residents, the total number of medications was higher and fall frequency and selected healthcare utilization measures were lower during the year following implementation of MTM based on TIME criteria. These findings suggest that MTM-guided prescription optimization may be associated with changes in clinical and healthcare utilization outcomes; however, the absence of a control group precludes causal inference, and randomized controlled trials are required to confirm these associations.

Inappropriate use of antimalarial medications can accelerate the development of antimicrobial resistance (AMR), undermining treatment efficacy and public health goals. Artemether-lumefantrine (A/L) is the first-line treatment for uncomplicated malaria in Nigeria, yet its misuse persists, particularly among young adults. This study assessed knowledge gaps in A/L use among university students in Southwestern Nigeria to identify opportunities for targeted intervention. A cross-sectional online survey was conducted among undergraduate students from three universities in Southwestern Nigeria. Respondents' knowledge of A/L was categorized as good (≥70%), fair (50-69%), or poor (<50%). Associations between knowledge and demographic or experiential variables were analysed using independent sample t-tests and one-way ANOVA, with significance set at p < 0.05. Data analysis was performed using SPSS version 27. A total of 392 students participated, with a mean age of 19.5 years; 58.4% were female. While 64.5% knew the correct timing for the second dose of A/L, only 22.2% correctly identified appropriate storage methods. About 94.9% preferred swallowing the drug with water after food, but many were unaware of common side effects or appropriate responses. Overall, 44.6% of students demonstrated poor knowledge of A/L use. Knowledge scores differed significantly by level of study (p = 0.001) and previous use of antimalarials (p = 0.04). Substantial knowledge gaps and misconceptions about A/L use exist among university students in Southwestern Nigeria. These findings underscore the urgent need for health education initiatives targeting young adults to promote safe and effective use of antimalarial medications and may inform health education strategies aimed at promoting rational antimalarial use and strengthening malaria control efforts.

Abstract Introduction The literature reports that people living with dementia (PLWD) are more frequently impacted by medication-related issues such as potentially inappropriate prescribing compared to older people without dementia.[1] Only a small number of prescribing tools (e.g. MATCH-D[2]) have been developed to guide prescribing and medication management for PLWD with development often taking a region-specific approach. Aim To explore the perspectives of researchers who have published work on medication use in older people and PLWD, regarding the need for a prescribing tool specific to PLWD. Methods Participants were purposively sampled through online searches of relevant published literature and personal contacts of the research team, with additional recruitment via snowballing. It was anticipated a priori that 10–15 interviews would be required to reach data saturation. Semi-structured interviews were conducted via Microsoft Teams, using a pre-prepared, piloted topic guide. Questions related to the suitability of current prescribing tools for PLWD, the need for a dementia-specific tool, and its content, should it be developed in the future. Interviews were audio-recorded and transcribed verbatim. Transcripts were independently coded by two researchers and analysed using inductive thematic analysis. Results Ten interviews were conducted, lasting between 14–29 minutes. Participants had varied backgrounds as pharmacists (n = 5), physicians (n = 4) and one with no clinical experience. Participants were based in Australasia (n = 4), Europe (n = 4) and North America (n = 2). Thematic analysis generated four themes. Within the first theme, ‘participant perspectives of using prescribing tools,’ participants described being familiar with a range of prescribing tools in both their research and clinical work, with many detailing their involvement in developing tools. The second theme, ‘existing prescribing tools: pros and cons,’ highlighted that tools could be useful for clinicians by identifying areas of focus, yet often lacked context of prescribing decisions and could be challenging to apply in a clinical setting: “[A prescribing tool] declares potentially inappropriate use of medications. It doesn’t flag actual inappropriate use of medications… ‘cause you don’t really have the full story” [R10]. The third theme, ‘unique medicines management challenges for PLWD,’ described how issues such as communication barriers and challenging decision-making made prescribing for PLWD more complex. Within the final theme, ‘making the case for a dementia-specific prescribing tool,’ most participants felt such a tool would be beneficial, as currently available tools only had limited usefulness for PLWD: “There’s no reason why these tools can’t be used for people with dementia, but they’re not specific for people with dementia” [R03]. Participants had mixed views about whether the tool should contain explicit or implicit criteria and recommended a range of areas of focus for a new tool, ranging from specific medications to palliative care guidance. Conclusion This study has identified the need for a dementia-specific prescribing tool, using robust methodology. However, as most participants were from similar geographical areas, study findings may not be generalisable to other regions. Further research will aim to reach consensus on the recommended content for this new tool should it be developed in the future, with an expert panel of researchers and clinicians.

Introduction: Anti-inflammatory drugs are widely used to treat pain and inflammation and are classified into Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and Steroidal Anti-Inflammatory Drugs (SAIDs). Although effective, these medications can cause adverse reactions. The pharmacist plays a crucial role in guiding proper use, promoting rational use, and minimizing the risks of self-medication and drug interactions. Objective: This study analyzed the use profile of NSAIDs and SAIDs in a pharmaceutical clinic between June 2022 and June 2024, considering age, socioeconomic status, weight, and gender. It also identified diseases associated with the use of these medications and included the development of an informational leaflet to raise awareness about the rational use of anti-inflammatory drugs and their therapeutic alternatives. Method: A retrospective, descriptive, quantitative, and cross-sectional study was conducted using the electronic medical record system “VIDA” for data collection and simple statistical analysis. Subsequently, an educational leaflet was developed for patients, addressing inappropriate medication use and non-pharmacological alternatives, such as Integrative and Complementary Health Practices (ICHP). Results: Of the 444 patients, 59 were selected. Most were female (81.4%) and over 45 years old (61%). Overweight prevalence was 39%, and comorbidities were present in 66.1% of cases. Low back pain was the most common complaint (50.8%). Diclofenac (32.2%), ibuprofen (20.3%), and nimesulide (15.2%) were the most commonly used drugs. Conclusions: The study revealed a predominant profile of women over 45 years old using NSAIDs, with a high prevalence of overweight and comorbidities.

Polypharmacy, a rising concern in the older adult population, is associated with significant risks, including adverse drug reactions and inappropriate medication use. Deprescribing, which is supported by effective communication between healthcare professionals and patients, has emerged as an important strategy to reduce potentially inappropriate medications. While numerous frameworks, guidelines, and tools exist to support healthcare professionals in deprescribing, many lack explicit integration of communication strategies, despite their critical role in shared decision-making and patient engagement. The aim of this rapid review was to synthesize and describe the existing deprescribing frameworks, guidelines, and tools used by healthcare professionals, with a focus on how communication is represented within them. The secondary objective was to extract communication elements from each of the deprescribing frameworks, guidelines, and tools. We used rapid review methodology recommended by the World Health Organization. The protocol was registered with the Open Science Framework and reported according to the PRISMA statement. CINAHL, Ovid Medline, and Scopus were searched from January 2003 to July 2024. Eligible studies focused on deprescribing frameworks, guidelines, or tools used by healthcare professionals caring for older adults (≥ 65 years). A qualitative synthesis of the evidence was conducted. The search retrieved 5177 articles. After removing 1704 duplicates, 3473 citations were screened for eligibility. Of those, 343 were reviewed in full, and 18 were included in the final synthesis. We identified three frameworks, two guidelines, and seven tools. Frameworks such as A-TAPER, TAPER, and the 10-Step Conceptual Framework emphasized patient-centered care but varied in approach. Communication strategies, shared decision-making, active listening, feedback, communication adaptation, and encouraging participation were present but not explicit. Most frameworks targeted physicians and pharmacists, with minimal involvement of nurses. Future deprescribing frameworks should explicitly integrate communication strategies and include nurses in their development. Building on these findings, our next step is to engage nurses to identify the most important communication characteristics for effective deprescribing conversations. These insights can guide the development of future frameworks, guidelines, and tools to support structured, patient-centered communication and improve deprescribing outcomes. This has important implications for clinical practice, education, and policy aimed at optimizing care for older adults.

The management of migraine, particularly the treatment of acute attacks, is frequently suboptimal, both among patients and physicians with limited expertise in this field. This situation is largely explained by the trivialization of the disease, leading to delayed healthcare seeking and inappropriate use of analgesics. Yet, migraine is a highly disabling disorder and a major public health concern. Given this substantial burden, the most immediate therapeutic strategy remains the treatment of acute attacks, with early and adequate administration increasing the likelihood of success while preventing inappropriate medication use. The aim of this article is to revisit the fundamental principles of acute migraine management in order to optimize its use, drawing on the most relevant guidelines, our clinical experience, and the Belgian pharmaco-economic context.

Polypharmacy in older adults is associated with medication-related harm, including adverse drug events, drug-drug interactions, inappropriate prescribing, and hospitalization-related outcomes. This systematic review evaluated the effectiveness and safety of pharmacist-led deprescribing interventions in adults aged ≥65 years. The review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement, and searches were conducted in PubMed, Embase, and Scopus for studies published from January 2020 to December 2024. Five studies met the inclusion criteria, including two randomized controlled trials and three quasi-experimental studies across inpatient, emergency department, and ambulatory settings. Pharmacist-led interventions were generally associated with reductions in potentially inappropriate medication use and improvements in medication appropriateness. Evidence regarding adverse drug events, hospital admissions/readmissions, mortality, and other major clinical outcomes remained limited and heterogeneous. Overall, pharmacist-led deprescribing appears feasible and may improve prescribing quality, but larger randomized studies with longer follow-up are needed to determine its effect on major clinical outcomes.

The objective of this project was to examine factors reported to affect changes in antipsychotic medication prescription and use in long-term care during the COVID-19 pandemic. Qualitative descriptive study. Continuing care (CC) facilities in Alberta, Canada. Participants were staff from CC who had worked during the pandemic, recruited from homes stratified by change in antipsychotic usage (decreased use, no change or increased use based on the Canadian Institute of Health Information (CIHI) quality indicator for potentially inappropriate antipsychotic medication use). Virtual interviews were conducted using a semi-structured guide. Data were inductively coded then mapped into the components of the Capability, Opportunity, Motivation-Behaviour system, which served as our lens to understand the factors influencing change in medication use over the pandemic. 44 staff members participated. Half worked at sites that experienced change in antipsychotic medication use. Many factors affected medication use. Primary motivations driving use included the need for staff to protect themselves and residents and increased staff stress. Opportunities to appropriately use antipsychotics were affected by policies requiring physical and social isolation and use of personal protective equipment. However, respondents demonstrated their capability of enacting appropriate use when describing their perspectives toward these medications. Staff attempted to provide quality care to residents aligned with antipsychotic medication guidelines while simultaneously complying with the restrictions and policies imposed during the COVID-19 pandemic. These findings highlight the factors influencing antipsychotic medication use among CC residents during the pandemic and may inform future planning or outbreak responses.

Adverse drug events (ADEs) are unintended harm resulting from appropriate or inappropriate medication use. Many ADE-related emergency department visits are repeat events that occur after re-exposure to a medication that previously caused harm. Identifying risks and risk factors for repeat ADEs could inform clinical decision-making. We conducted a systematic review of literature on repeat ADEs published over a 20-year period. We applied a predefined search strategy in MEDLINE, Embase, and Scopus and extracted data on risk factors (e.g., age, sex, drug type, re-exposure type) and ADE outcomes. We conducted a meta-analysis if 2 or more studies reported on the same drug class, re-exposure type, ADE outcome, and follow-up period. We screened 13,452 articles and included 55. Most studies reported on re-exposures to the same drug (n=44), with few reporting on exposures to new drugs (n=5). The most studied drug classes were antineoplastics (n=20), anticoagulants (n=10), and antibiotics (n=5). The proportion of Repeat ADEs varied widely across studies from <1 to 88%. We were only able to pool data from studies on re-exposure to anticoagulants and found that 10% (95% confidence interval: 4%-19%) rebled within 90 days. Repeat ADE risks varied by drug class, reflecting different patient populations, medications and indicating conditions. Inconsistent reporting prevented quantification of risk factors. Pooled repeat ADE incidence, where available, can inform shared decision-making by providing estimates of ADE risk in the context of re-exposures to treat underlying conditions. Repeat ADEs remain an understudied area, highlighting the need for further research given their clinical significance.

Background: Multimorbidity poses a significant challenge for healthcare systems. There is an urgent need for targeted interventions for individuals with high complexity to better coordinate care across hospital specialists and to support general practice. However, there is limited evidence on how best to organise this care. We propose a differentiated care approach through our Clinic for Multimorbidity to provide specialised care at the required level. Approach: We have redesigned our existing 'Clinic for Multimorbidity', which has existed since 2012. The clinic aims to integrate care from various healthcare professionals and medical specialties, promoting shared and coordinated care for adults with complex multimorbidity. The patients are referred from general practice. Healthcare professionals and researchers involved in the clinic, re-designed the clinic with differentiated care options according to the required level of support: I.A telephone line for general practitioners with specialist advice about the management of multimorbidity and/or polypharmacy. II.A medication review with the patient present, conducted by a specialist in clinical pharmacology. Medication changes are agreed upon with the patient and followed up with control consultations. III.A patient consultation with a physician, including review of previous medical records and current medications, as well as assessments from occupational and physical therapists. After the patient consultation, a multidisciplinary team meeting is held with selected medical specialists, to develop a treatment plan. The patient's general practitioner can participate via video. In agreement with the patient, a nurse coordinator facilitates follow-up based on the recommendations. Using a stepped-wedge randomized controlled design, general practices are enrolled based on their geographical locations as hospital clusters. The project includes two studies within the fields of clinical and health services research: an implementation study to assess the feasibility of the differentiated pathways and an effect study. Results: The data collection began in September 2024. The implementation study results will be based on Proctor et al.'s implementation outcomes: acceptability, adoption, appropriateness, feasibility, fidelity, and penetration. Data will be gathered through interviews with patients and general practitioners, as well as measurements related to referral practices, costs, and feasibility. Effectiveness outcomes will involve perceived health-related quality of life, treatment burden, depression, and anxiety. Additionally, inappropriate medication, symptoms, mortality, care continuity, healthcare utilization, and the initiation of health-promoting initiatives. Implications: Complex multimorbidity and polypharmacy necessitate multidisciplinary approaches and stepped care to fit the appropriate level of care. We propose a differentiated model aimed at improving patient well-being and care, reduce inappropriate medication use, and support general practitioners and hospitals in their management of these patients, allowing for more efficient resource allocation. From phone consultations to multidisciplinary assessments, other healthcare settings can adjust the level of care according to their capacities and patient needs, making this a scalable model.

Perceived Confidence and Barriers of Family Physicians Toward Deprescribing Potentially Inappropriate and Preventive Medications in Older Adults: A Cross-Sectional Survey in Riyadh, Saudi Arabia.

Due to the complexity of medication use in older adult patients living with cancer, the risk of potentially inappropriate medications (PIMs) was significantly increased, yet evaluation criteria vary. Therefore, this study aimed to detect the PIMs use by the 2023 American Geriatrics Society (AGS) Beers criteria, the 2023 Screening Tool of Older Persons’ Prescriptions (STOPP) criteria, the geriatric oncology potentially inappropriate medication (GO-PIM) scale, and the 2024 Chinese criteria in older adult patients living with cancer and compare the prevalence of PIMs and the accordance between the 4 PIM criteria; and further to explore related risk factors for PIMs according to the 4 criteria. This retrospective study included 484 older adult patients living with cancer. PIMs were analyzed based on the 4 criteria. The consistency of the evaluation results was compared between the 4 criteria, and influencing factors for PIMs were analyzed using multivariate logistic regression. The incidence of PIMs in older adult patients living with cancer was high in our study, with certain differences in consistency among the 4 criteria. The 2024 Chinese criteria were the most sensitive for identifying PIMs, and polypharmacy was the main influencing factor for the occurrence of PIMs in all criteria. It is necessary to strengthen medication therapy management for older adult patients living with cancer. The prevalence of at least one PIM identified by the 4 criteria ranged from 42.15% to 71.07%. The drugs with the highest incidence were metoclopramide, medroxyprogesterone, and cimetidine. The kappa statistics for the 2023 AGS/Beers criteria with the 2024 Chinese criteria, the GO-PIM scale and 2024 Chinese criteria indicated a good concordance (κ = 0.788 and 0810). The consistency between the 2023 AGS/Beers criteria and the 2023 STOPP criteria, the GO-PIM scale were moderate (κ = 0.459 and 0732). The consistency between the 2023 STOPP criteria and the 2024 Chinese criteria was moderate (κ = 0.448), but with the GO-PIM scale was poor (κ = 0.345). The results of multiple logistic regression analysis showed that polypharmacy was the main influencing factor for the occurrence of PIMs in all criteria (P<.001).

Aim: This study aimed to investigate the impact of coronavirus disease 2019 (COVID-19) infection on anemia, polypharmacy, inappropriate medication use, and the prescription of antidepressants, antipsychotics, and analgesics.Specifically, it compared medication use and associated health outcomes before and after COVID-19 infection. Materials and Methods:A retrospective analysis was conducted using data from the national health registry system, including 354 patients who had COVID-19 between March 2020 and December 2022.Data on comorbidities, medication use, and hemoglobin levels were collected for six months before and after COVID-19 diagnosis. Results:The study revealed significant increases in anemia, polypharmacy, antidepressant use, antipsychotic use, and analgesic use post-COVID-19 infection (p<0.05).Subgroup analyses showed significant increases in analgesic use, including paracetamol, non-steroidal anti-inflammatory drugs, opioids, and gabapentinoids (gabapentin and pregabalin).Multivariate logistic regression indicated that antipsychotic use after COVID-19 infection independently increased the likelihood of anemia (odds ratio: 2.99, 95%, confidence interval: 1.08-8.29,p<0.05). Conclusion:The study found significant increases in anemia, polypharmacy, and the use of antidepressants, antipsychotics, and analgesics following COVID-19 infection.These findings emphasize the need for careful monitoring of medication use and anemia in post-COVID-19 patients and highlight the importance of appropriate prescription practices to mitigate long-term healthcare risks.

To determine the prevalence of potentially inappropriate prescribing (PIP), potentially inappropriate medication (PIM), potential prescription omission (PPO), potentially harmful drug-drug interactions (PDDI) and identify associated factors among older Ethiopians. Systematic review and meta-analysis DATA SOURCE: We searched PubMed, HINARI, Scopus and Web of Science databases to identify eligible studies published up to 31 October 2025. Observational studies reported the prevalence of PIP, PIM, PPO and PDDI among older adults from any healthcare settings were screened. Two independent reviewers selected studies, extracted data and assessed the risk of bias. The quality and risk of bias of the studies were assessed using the Newcastle-Ottawa scale and Hoy risk of bias tool, respectively, while the certainty of evidence of outcomes was assessed using Grading of Recommendations, Assessment, Development and Evaluation based on Cochrane recommendations. We used a random-effects model for analyses to estimate the pooled prevalence and associated factors. All data analyses were done using Stata V.17 software. The national prevalence of PIP, PIM, PPO and PDDI was estimated as main outcomes. Variations were estimated based on regions, age groups, outcome evaluation tool, disease type and healthcare setting. The review included 25 studies (n=5662 participants) for PIP or PIM, 14 studies (n=2706 participants) for PDDI and 6 studies (n=1342 participants) for PPO. The pooled prevalence estimate was 41% (95% CI 33% to 48%), I2=96.87% for PIP, 37% (95% CI 31% to 44%), I2=96.33% for PIM, 55% (95% CI 36% to 73%), I2=99.00% for PDDI and 14% (95% CI 6% to 24%), I2=95.07% for PPO. The majority of the studies have very good quality (very good=13, good=1, satisfactory=11 for PIP and PIM; very good=11, satisfactory=3 for PDDI; very good=6 for PPO) and low risk of bias (low risk=18, moderate risk=7 for PIP and PIM; low risk=12, moderate risk=2 for PDDI and low risk=6 for PPO), while all studies for each outcome have low certainty of evidence. Subgroup analyses revealed significant regional and contextual variations. Polypharmacy was significantly associated with PIP (OR=3.72, 95% CI 2.53 to 5.46, p<0.01, I2=69.56%), PIM (OR=4.20, 95% CI 2.91 to 6.06, p<0.01, I2=57.83%) and PDDI (OR=4.51, 95% CI 3.05 to 6.69, p<0.01, I2=0.00%), while hypertension (OR=2.46, 95% CI 1.38 to 4.36, p<0.01 I2=0.00%) was associated with PIP. This review found a high prevalence of PIP, PIM, PDDI and PPO among older adults in Ethiopia, with notable heterogeneity across regions. Polypharmacy was associated with PIP, PIM and PDDI, while hypertension showed association with PIP. Despite generally good study quality, the certainty of evidence was low for the included studies due to the cross-sectional design nature, with high heterogeneity. Therefore, these findings should be interpreted cautiously. This study indicates a high burden of inappropriate medication prescribing and its associated factors, underscoring the importance of further robust studies to clarify prescribing practices and associated factors. CRD42024556744.

Introduction: Climate change is associated with increasing frequency and severity of extreme weather events, but little is known about the impact of disaster exposure on people living with dementia (PLWD). PLWD may experience increased confusion, disorientation, anxiety, and paranoia during disasters, potentially leading to the inappropriate use of psychotropic medications as a form of symptom management. This study examined new psychotropic prescription medications or changes to existing prescriptions among US Medicare beneficiaries with a dementia diagnosis following hurricane exposure. Methods: This study used a retrospective cohort design with administrative claims data from Medicare beneficiaries diagnosed with dementia. The study population included 71,401 beneficiaries residing in counties exposed to Hurricanes Harvey, Irma, or Florence between 2017 and 2018. Exposure to major hurricanes (Harvey, Irma, and Florence) was determined based on Federal Emergency Management Agency disaster declarations for affected counties. The primary outcome was the rate of new psychotropic prescriptions or changes to existing prescriptions within 12 months post-hurricane exposure, compared between beneficiaries in exposed versus unexposed counties. Results: PLWD exposed to hurricanes had a 10% higher rate of starting new antipsychotic prescriptions compared to those in unexposed counties (Incidence Rate Ratio [IRR]: 1.10; 95% CI, 1.04-1.17). Exposure to Hurricane Harvey was associated with a 20% higher rate of new antipsychotic prescriptions (IRR: 1.20; 95% CI, 1.07-1.36), while no significant changes were observed following Hurricanes Irma (IRR: 0.99; 95% CI, 0.90-1.08) or Florence (IRR: 0.92; 95% CI, 0.80-1.05). Conclusion: Exposure to Hurricane Harvey was associated with increased rates of new antipsychotic prescriptions among PLWD, suggesting that tailored disaster preparedness and response strategies are needed to address the unique needs of this vulnerable population. Understanding patterns in psychotropic medication prescribing among PLWD before, during, and after disasters is essential to improving disaster readiness and reducing inappropriate medication use.