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.

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.

Aim: Polypharmacy is increasingly prevalent among older adults and has been suggested as a potential risk factor for adverse health outcomes, including cognitive impairment and functional decline. Therefore, this study aimed to investigate the associations of polypharmacy with cognitive impairment and functional status among community-dwelling older adults using nationally representative data from the 2023 Korean Elderly Survey. Methods: A cross-sectional analysis was conducted using data from 9,898 community-dwelling older adults without a diagnosis of dementia. Polypharmacy was defined as the concurrent use of five or more physician-prescribed medications. Cognitive function was assessed using the Korean version of the Mini-Mental State Examination (K-MMSE), with cognitive impairment defined as a score ≤ 23. Functional status was evaluated using the Korean Activities of Daily Living (K-ADL) and Korean Instrumental Activities of Daily Living (K-IADL). Logistic regression was used to estimate odds ratios and 95% confidence intervals (CIs) for cognitive impairment, while multiple linear regression analyses examined associations with functional status. Models were sequentially adjusted for sociodemographic characteristics, health behaviors, and the number of chronic diseases. Results: Polypharmacy was associated with increased odds of cognitive impairment in the crude model (OR = 1.70, 95% CI: 1.40–2.05); however, this association was attenuated and became non-significant after adjustment for sociodemographic and health-related factors. In contrast, polypharmacy remained independently associated with poorer functional status in fully adjusted models, showing higher K-ADL scores (B = 0.14, p = 0.007) and K-IADL scores (B = 0.43, p &lt; 0.001). Conclusions: Polypharmacy was independently associated with functional impairment but not with cognitive impairment after comprehensive adjustment, suggesting that functional decline may represent a more sensitive and immediate consequence of complex medication use in older adults. These findings underscore the need for comprehensive geriatric assessment approaches that integrate medication review with functional evaluation.

BackgroundAnticholinergic medications carry increased risk of worsening cognition, particularly in patients with dementia.ObjectiveCognitive and functional scores of patients were compared at 1-year follow up after cessation of prior anticholinergic medications to those who were not taking anticholinergics at baseline to assess whether prior anticholinergic use affected dementia prognosis in memory clinic patients.MethodsLongitudinal data from 578 consecutive patients with diagnoses including Alzheimer's disease (AD), frontotemporal and vascular dementia, Lewy body dementia, mild cognitive impairment and dementia due to non-AD etiologies compared patients taking anticholinergic drugs to those taking none at intake. Anticholinergic drugs were discontinued in all patients at initial visit. Mini-Mental Status Examination (MMSE) and Functional Activities Questionnaire (FAQ) were administered at intake and 1-year follow up.ResultsBetween the no-anticholinergic and anticholinergic groups, MMSE at baseline did not significantly differ when the entire sample was compared. In addition, MMSE score change between baseline and follow-up did not significantly differ. Similarly, no significant differences were observed between groups in FAQ at baseline or in FAQ change between timepoints. Subgroup analysis of only those with AD yielded statistically significant differences in initial MMSE. However, these groups had statistically similar follow-up MMSE. Although initial FAQ scores were similar, there were significant differences in follow-up FAQ in patients with AD.ConclusionsFindings suggest that patients with AD presenting on anticholinergic medications may do worse cognitively and functionally than those who were never on anticholinergics despite baseline discontinuation. Anticholinergic medication use in older adults should be approached cautiously.

Deprescribing, the process of stopping unnecessary medications, is essential for optimizing pharmacotherapy in older adults but is hindered by systemic, knowledge and patient-related barriers. This study explored physicians' perspectives on barriers and facilitators to deprescribing in older adults using the Theoretical Domains Framework (TDF), in an LMIC setting with limited evidence. A qualitative study was conducted using in-depth interviews with physicians (n = 52) to explore barriers, facilitators and potential improvements in deprescribing practices. Thematic analysis was applied to identify key insights and patterns from the collected data. This study identified several barriers to deprescribing, including limited healthcare access in rural areas and knowledge gaps in geriatric pharmacology among resident doctors. Patient-specific challenges, such as advanced age and multiple comorbidities, further complicated the process. The chronic use of medications like proton pump inhibitors (PPIs) and benzodiazepines was also a prominent barrier. Systemic and logistical issues, such as inefficient workflows and poor interdisciplinary coordination, were noted as critical impediments. Key facilitators included patient acceptance, which was pivotal for adherence and outcomes, and the active participation of educated patients in shared decision-making processes. A growing acceptance of deprescribing among doctors, especially in government healthcare, was observed, with effective communication key to overcoming patient resistance and building trust. Overcoming systemic barriers, enhancing patient education and implementing structured guidelines are key to improving deprescribing. Interdisciplinary collaboration and digital tools like electronic health records can further ensure safe medication discontinuation. Targeted interventions are essential to optimizing deprescribing and improving older adult's health outcomes.

Spotlight commentary: Deprescribing in long-term care facilities-Towards safer and smarter medication use in older adults.

To evaluate the prevalence and types of potentially inappropriate prescriptions (PIP) in hospitalized older adults and to study whether PIP was a causative factor for index hospitalization, using the Turkish Inappropriate Medication Use in oldEr adults (TIME) criteria. This multicenter, cross-sectional study included 405 inpatients aged ≥60 years from 13 tertiary hospital departments in Turkiye between January 2020 and April 2021. PIP were assessed using TIME criteria, which include both potentially inappropriate medications, PIM (TIME-to-STOP) and potential prescribing omissions, PPO (TIME-to-START). Following the completion of medical history taking, physical examination, and comprehensive geriatric assessment (CGA), managing physicians evaluated each criterion individually. Based on clinical adjudication, they determined whether any PIM or PPO predefined in the TIME criteria could plausibly have contributed to the hospitalization. The prevalence of PIP was 82.5%, with 63.2% of patients meeting at least one TIME-to-STOP and 71.6% meeting one TIME-to-START criterion. The top-three most common PIM identified via TIME-to-STOP criteria were: Long-term proton pump inhibitor (PPI) use without indication with 7.2%, PPI use for uncomplicated peptic ulcer disease, or erosive peptic esophagitis at full therapeutic dose for > 8-12 weeks with 3.0%, and diuretic use as first-line treatment of essential hypertension with concurrent urinary incontinence with 3.0%. The top-three most common PPO identified via TIME-to-START criteria were: Herpes zoster vaccination with 73.6%, Seasonal influenza vaccination annually with 59.3%, and Pneumococcal vaccination after age 65 with 57.3%. Among all participants, 34.1% had PIP causally related to hospitalization. Overtreatment of hypertension in patients with frailty was the most common PIM-related hospitalization factor (2.5%). Lack of oral nutritional supplements in patients with malnutrition was the leading PPO linked to hospitalization (11.6%). PIP were highly prevalent in hospitalized older adults and frequently contributed to hospital admission. TIME criteria provided a comprehensive and context-adapted tool for identifying both inappropriate medication use and missed treatment opportunities. Routine implementation of TIME criteria-guided medication reviews may represent a promising strategy to enhance medication safety and reduce avoidable hospitalizations in older populations, warranting further investigation.

Background/Objectives: Chronic kidney disease (CKD) in older adults is frequently accompanied by substantial medication burden, increasing risks of adverse drug events and poor adherence. The Planetary Health Diet Index (PHDI), emphasizing plant-based foods and sustainable dietary patterns, may improve cardiometabolic health and reduce medication requirements. This study examined the association between PHD adherence as measured by the PHDI and medication burden among older adults with CKD. Methods: We analyzed cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2003-2018 cycles. Older individuals aged ≥ 65 years with CKD (estimated glomerular filtration rate < 60 mL/min/1.73 m2 or albumin-to-creatinine ratio > 30 mg/g) at the baseline visit were included (n = 3161). PHDI scores (0-150) were calculated from two consecutive 24 h dietary recalls. Medication burden was assessed as the total prescription medication count and frequency of individual classes. Multivariable Poisson regression models evaluated associations between PHDI score and number of prescribed medications, adjusting for sociodemographic, lifestyle, and clinical covariates; logistic regression models were used to evaluate the association between PHDI score and specific medication classes. Results: Mean (SD) age was 75.0 (5.5) years; mean PHDI score was 62.4 (18.7). Participants in the highest PHDI tertile had significantly lower medication burden compared to the lowest tertile. In fully adjusted Poisson regression models, each 10-point increase in PHDI score was associated with 3% fewer medications (RR: 0.97, 95% CI: 0.96-0.99, p = 0.011). Participants in the highest PHDI tertile had 8% fewer medications compared to the lowest tertile (RR: 0.92, 95% CI: 0.87-0.98, p = 0.013). Higher PHDI scores were significantly associated with lower odds of proton pump inhibitor use (OR: 0.86, 95% CI: 0.79-0.94 per 10-point increase) and nonsteroidal anti-inflammatory drug prescription (OR: 0.86, 95% CI: 0.76-0.97 per 10-point increase). Participants in the highest PHDI tertile had 34% lower odds of PPI use (OR: 0.66, 95% CI: 0.49-0.89) and nonsignificant lower odds of NSAID use (OR: 0.67, 95% CI: 0.40-1.11) compared to those in the lowest tertile. Conclusions: Higher PHDI adherence was independently associated with lower medication burden in older adults with CKD. These findings suggest that plant-forward, sustainable dietary patterns may reduce pharmacological complexity in this vulnerable population. Prospective studies are needed to assess causality and clinical implementation strategies.

Few studies have examined the occurrence of adverse drug reactions (ADRs) in relation to the severity of cognitive impairment in patients with dementia. This study aimed to investigate the prevalence of ADRs among older adults living with dementia at the time of admission according to the severity of cognitive impairment. This retrospective chart review included patients living with dementia between July 2021 and December 2022. Severity of cognitive impairment was classified using the Mini-Mental State Examination scores as mild (≥ 21), moderate (11-20), and severe (≤ 10). ADRs were evaluated based on national guidelines for appropriate medication use in older adults or pharmacologically plausible associations. ADR-related hospitalization was defined as ADRs that were considered to have directly or indirectly contributed to the decision to admit the patient. The collected data and the relationship between medication counts and ADR-related hospitalization (6-9 versus ≥ 10 medications) were analyzed according to the severity of cognitive impairment. This study included 35, 100, and 78 patients in the mild, moderate, and severe groups, respectively. At discharge, the severe group was prescribed significantly fewer medications than the mild group (p < 0.05). The prevalence of ADRs decreased in each group from admission to discharge (mild: 77.1%-17.1%; moderate: 74.0%-16.0%; severe, 82.1%-33.3%). Among patients taking 6-9 medications, ADR-related hospitalization was more common in the severe (50.0%) group than the mild group (20.0%) (p < 0.016) at the time of admission. Patients living with dementia who have severe cognitive impairment are particularly vulnerable to adverse drug reactions.

BackgroundImproving medication use is important in patients with cognitive impairment and dementia. In memory clinics within primary-care settings, pharmacists perform structured medication reviews targeting medication-related problems in this population. The impact of pharmacist-led medication reviews in such clinics has not been examined previously. However, implementing research in clinical environments is fraught with challenges. Thus, this research focuses on identifying barriers and facilitators that would impact the implementation of research projects examining medication reviews in primary-care based memory clinics.MethodsWe conducted a qualitative study using focus group discussions with pharmacists, physicians, care partners, and other healthcare professionals. Semi-structured guides informed by the Theoretical Domains Framework (TDF) were used to facilitate discussions. Using the TDF–COM-B (Capabilities-Opportunities-Motivation-Behaviour) approach, we identified and analyzed barriers and facilitators to implementing research on pharmacist-led medication reviews and generated potential intervention strategies.ResultsEighteen stakeholders across three focus groups identified several key barriers, including communication gaps, unclear interdisciplinary roles, participant burden, and limited resources across multiple TDF domains. Facilitators included the perceived impact of medication reviews (beliefs about consequences), patient involvement in research (decision processes), study procedural knowledge (knowledge), pharmacist recognition (social/professional role and identity), and standardized medication reviews (skills). Implementation strategies included providing standardized training, simplifying study procedures with digital tools and templates, involving study coordinators, and engaging patients and care partners in decision-making. Barriers such as communication gaps, unclear interdisciplinary roles, participant burden, and resource constraints were addressed through workflow redesign, financial incentives, and fostering collaboration and institutional support.ConclusionThis study identified key barriers and facilitators to implementing research on pharmacist-led medication reviews in memory clinics, highlighting several areas with direct policy relevance. These findings point to important policy needs, including clearer interdisciplinary roles, improved communication, adequate resource support, and standardized training to enhance the feasibility and sustainability of pharmacist-led medication review interventions, ultimately supporting successful research implementation and improving medication use in older adults with cognitive impairment and dementia.

The use of potentially inappropriate medications (PIMs) represents a priority issue in the care of older adults. This age group experiences physiological changes that alter the pharmacokinetics and pharmacodynamics of medications, increasing the risk of adverse effects, interactions, and avoidable hospitalizations. This study aims to determine the prevalence of use of potentially inappropriate medications, specifically benzodiazepines (BZDs), nonsteroidal anti-inflammatory drugs (NSAIDs), and proton pump inhibitors (PPIs), in older adult patients receiving home care in the City of Buenos Aires. An observational, descriptive, and cross-sectional study was conducted on a sample of 51 patients from the Home Care Service in Buenos Aires City. Mean age was 84.2 years (range 70–108). Polypharmacy (≥5 drugs) was present in 67.3 % of patients and extreme polypharmacy (≥10 drugs) in 16%. At least one potentially inappropriate medication was used by 69.1% of patients, mainly benzodiazepines (55%) and proton pump inhibitors (35%), with nonsteroidal anti-inflammatory drugs accounting for 24%. The findings reinforce the need to optimize prescribing and promote rational deprescribing strategies in the home setting.

Older adults frequently use medications deemed high-risk, despite clinical recommendations supporting their discontinuation. We conducted a retrospective cohort study using administrative claims data from a large national U.S. health insurer (2017-2023) to assess high-risk medication discontinuation among adults aged ≥65 years and their association with sociodemographic factors. Among 729,705 long-term users of high-risk medications (mean age 74 [SD: 7], 59% female), only 22.8% discontinued for ≥90 consecutive days without subsequent refills (mean follow-up: 626 days). Discontinuation was more likely among Black adults (HR = 1.07, 95% CI: 1.03-1.11), particularly between 2020-2021, while men (HR = 0.89, 95% CI: 0.87-0.91) and those aged ≥75 years (HR = 0.86, 95% CI: 0.84-0.91) were less likely to discontinue compared to women and younger older adults, respectively. Notably, the combined effect of male gender and older age was associated with increased discontinuation (HR = 1.04, 95% CI: 1.02-1.06), whereas other sociodemographic combinations showed no meaningful interaction. When stratified by medication class, significant variation persisted for central nervous system, gastrointestinal, and pain medications but not for endocrine or cardiovascular medications. These findings highlight persistently low discontinuation rates and suggest the need for targeted interventions to reduce inappropriate medication use in older adults.

Potentially inappropriate medication use by TIME criteria in nursing home residents and its relationship with common geriatric syndromes.

Background/Objectives: Older adults should be capable of reasoned judgments regarding their health, lifestyle, and disease management. Therefore, interventions to improve Health Literacy (HL) are essential for empowering older adults to make choices that improve their quality of life. Correct medication use is vital to maintaining and enhancing health outcomes in older adults. This study aimed to identify the most effective HL interventions with impact on medication use among older adults. Methods: A systematic review was conducted using MEDLINE (PubMed) and EMBASE to identify interventional studies evaluating HL interventions that have an impact on medication use in older adults. Results: Three studies satisfied the inclusion criteria. The evidence indicates that HL interventions have positive effects and can be effectively implemented by several healthcare professionals through tailored communication strategies. However, the review underscores a substantial lack of high-quality research on HL strategies aimed at improving medication use in older adults, particularly given the increasing prevalence of chronic diseases and polypharmacy in this population. Conclusions: This systematic review identifies substantial research gaps regarding HL interventions and their impact on medication use among older adults. While the included studies demonstrate encouraging outcomes, further rigorous research is necessary to develop specific HL interventions addressing medication-related challenges in older adults.

The global aging population faces increasing risks of supplement-drug interactions due to rising polypharmacy and widespread use of nutritional supplements. Older adults, particularly those with chronic conditions, frequently combine prescription medications with dietary supplements, yet healthcare providers often overlook these interactions, leading to preventable adverse effects. This review synthesizes evidence from 16 international studies spanning nearly three decades, examining the intersection of supplement and medication use in older adults. Key findings reveal a high prevalence of concurrent use (23-82.5%), significantly increasing the likelihood of adverse interactions, particularly with antithrombotics (e.g., warfarin and ginkgo) and absorption-disrupting minerals (e.g., calcium and levothyroxine). A critical systemic failure in patient-provider communication exacerbates these risks, as clinicians often neglect to inquire about supplement use. Despite widespread potential interactions, actual clinical harm appears concentrated in high-risk combinations. The review calls for proactive clinical strategies, including standardized supplement screening, targeted patient education, and pharmacist-led medication management. Its limitations include cross-sectional study designs and self-reported data, underscoring the need for longitudinal and intervention-based research. Future studies should prioritize causal evidence, standardized methodologies, and data from low- and middle-income countries to mitigate risks in aging populations.

The AGS 2023 updated Beers Criteria for potentially inappropriate medication use in older adults recommends avoidance of skeletal muscle relaxants (SMRs) for musculoskeletal complaints. Two SMRs, baclofen and tizanidine, are excluded from this criterion. Clinicians may therefore consider baclofen or tizanidine as options for older adult patients with musculoskeletal complaints; however, evidence for this conclusion is lacking. To investigate injury events associated with baclofen and tizanidine in older adults compared to cyclobenzaprine, an SMR included in the Beers Criteria. We conducted a retrospective cohort study at Kaiser Permanente Southern California (KPSC) in patients age 65 to 99 years. Participants were identified as KPSC members dispensed a study SMR between January 1, 2008, and December 31, 2018. Serious injury events were identified in the electronic medical record using ICD-9 and ICD-10 codes for the following: fracture, fall leading to fracture, brain injury, and dislocation injury. Findings were adjusted for numerous demographic and clinical covariates. Secondary analyses investigated injury-free probabilities based on the type of injury event. From a population of 87,896 participants, 118,426 study medication episodes were identified. Compared with cyclobenzaprine, baclofen demonstrated a 69% greater risk (adjusted Hazard Ratio [aHR] 1.69, 95% Confidence Interval [CI] 1.51-1.88), and tizanidine carried a 34% greater risk (aHR 1.34, 95% CI 1.11-1.62) for composite injury outcomes. Both baclofen and tizanidine demonstrated lower injury-free probabilities over time when compared with cyclobenzaprine. Older adult patients dispensed baclofen or tizanidine were found to have an increased risk of injury when compared with cyclobenzaprine, currently included on the Beers Criteria. These findings support the inclusion of baclofen and tizanidine on the Beers Criteria along with other SMRs as potentially inappropriate medications in use in older adults with musculoskeletal complaints. Due to a retrospective design, the risk for residual confounding may remain.

This scoping review provides an overview of tools used to assess potentially inappropriate prescribing among older adults and discusses their suitability for register-based research. We performed a systematic search using PubMed (March 2024), retrieving 5493 records. Studies were included if they evaluated potentially inappropriate medication use among older adults with a mean or median age of ≥ 65 years. Identified tools were described by characteristics, usage frequency, and applicability to register-based research by identifying required data types. A total of 419 studies were included, using 44 different tools, including multiple versions. Beers criteria and the Screening Tool of Older People's Prescriptions were most often used (50% and 19%, respectively). Ten tools were used in five or more studies, each differing in structure, particularly regarding the clinical information required. The European list of potentially inappropriate medications, the PRISCUS list, the Zhan criteria, and the Norwegian General Practice criteria do not require clinical data on medical history, symptoms, laboratory tests or other parameters, making them particularly useful for register-based research. Specific segments of other tools can also be applied effectively. To generate valid and meaningful results, the availability of required data is a crucial consideration for researchers when selecting the most appropriate tool.

Equipping physicians for benzodiazepine receptor agonists deprescription in older adults: theory-based development of the BE-SAFE intervention.

ABSTRACT Peer-based empowerment with peer groups’ informational, emotional, and evaluative support is recognized as a suitable motivator for adherence to recommended therapeutic regimens. Therefore, the study aimed to investigate the effect of peer-based empowerment through WhatsApp on self-efficacy for appropriate medication use in older adults with diabetes. A quasi-experimental design with a pretest-posttest control group design was carried out. The study population consisted of older adults with diabetes residing in the City of Rafsanjan, Iran. Two health centers, similar in socio-economic and cultural characteristics, were selected, with one assigned to the control group and the other to the intervention group. Thirty-two older adults with diabetes were then randomly selected from each center. The intervention group received a peer-based empowerment program, while the control group did not receive any intervention. Data were collected using the Self-Efficacy for Appropriate Medication Use Scale (SEAMS) at three time points before the intervention, immediately after, and three months post-intervention. Data were analyzed using SPSS v22. SEAMS mean scores significantly increased immediately after and three months after the intervention compared to baseline in the intervention group and increased significantly in the control group, although the increase in the mean scores was higher in the intervention group (p < .001). Peer-based empowerment appears to be an effective intervention for enhancing self-efficacy for appropriate medication use in older adults with type 2 diabetes. Furthermore, it can be easily used for improving adherence to medication regimens in other chronic diseases.

Psychotropic medications are associated with an increased risk of adverse drug events in older adults, yet national data on their use in Australia remain limited. This study aims to estimate the prevalence of psychotropic medication use among older Australians and to examine the sociodemographic factors associated with their use. A retrospective cross-sectional study was conducted using national linked data from the 2021 Census and the Pharmaceutical Benefits Scheme (PBS). The study included all individuals aged 65+ years who responded to the 2021 Census and received at least one PBS medication between 1 August and 31 October 2021. Prevalence of psychotropic medication use was calculated across 5-year age groups, and sociodemographic factors associated with each psychotropic subclass were assessed by logistic regression model. Among the 3,850,281 older adults, 31.1% received at least one psychotropic medication. Prevalence increased with age across all subclasses except antiepileptics. Antidepressants were the most commonly used psychotropics (19.9%). Those needing assistance with core activities (odds ratio, OR 2.05, 95% confidence intervals, CI 2.03-2.06) and living in non-private dwellings (OR 2.02, 95% CI 1.99-2.05) were more likely to receive psychotropics. Conversely, higher educational level, socioeconomic status and non-English speaker were associated with a lower use of all psychotropic subclasses. Aboriginal and Torres Strait Islander people were linked to increased use of benzodiazepines (OR, 1.15; 95% CI 1.10-1.20) and opioids (OR, 1.20; 95% CI 1.16-1.23). Dementia was strongly associated with antipsychotic (OR, 2.59; 95% CI 2.52-2.66) and antidepressant (OR, 1.42; 95% CI 1.40-1.44) use. Arthritis significantly increased the likelihood of opioid use (OR, 2.03; 95% CI 2.02-2.05). Almost one third of the study population used psychotropic medications between August and October 2021. Aboriginal and Torres Strait Islander people, individuals with dementia and those with arthritis had an increased likelihood of using certain psychotropic medications. Future research should evaluate the clinical appropriateness of psychotropics in these populations, with immediate implementation of strategies to ensure that their use is limited to evidence-based indications.