European Journal of Clinical Pharmacology

, Volume 74, Issue 6, pp 679–700 | Cite as

Potentially inappropriate medication in the elderly: a systematic review of validated explicit criteria

  • Fabiane Raquel MotterEmail author
  • Janaína Soder Fritzen
  • Sarah Nicole Hilmer
  • Érika Vieira Paniz
  • Vera Maria Vieira Paniz



Potentially inappropriate medication (PIM) use causes preventable adverse drug reactions in older patients. Several assessment tools have been published to identify and avoid PIM use. In this systematic literature review, we aim to provide summaries and comparisons of validated PIMs lists published between 1991 and 2017 internationally.


In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA), we performed a systematic review of articles describing the development and validation of criteria for identification of PIMs among older people published between January 1991 and April 2017. The searches were conducted on PUBMED, AgeLine, Academic Search, Academic Search Premier, and CINAHL. We identified the most common medications/classes described as PIM. We also identified the drug–disease interactions and drug–drug interactions reported among criteria.


From 2933 articles screened, 36 met our inclusion criteria. The majority used the Delphi method to validate their criteria. We identified 907 different medications/classes, 536 different drug disease interactions involving 84 diseases/conditions, and 159 drug–drug interactions. Benzodiazepines and nonsteroidal anti-inflammatory drugs were the medications most commonly reported as potentially inappropriate for older people.


Although approaches aimed at detecting inappropriate prescribing have intensified in recent years, we observed limited overlap between different PIM lists. Additionally, some PIM lists did not provide special considerations of use and alternative therapies to avoid PIMs. These facts may compromise the use of PIM lists in clinical practice. Future PIM lists should integrate information about alternative therapies and special considerations of use in order to help clinicians in the drug prescription.


Inappropriate prescribing Potentially inappropriate medication list Drug-related side effects and adverse reactions Aged 



We thank to the Coordination for the Improvement of Higher Education Personnel, National Council for Scientific and Technological Development for the support that they are providing for development of this study.

Author contributions

FRM and VPM participated in all stages of this project, from the design and interpretation of data to its final writing. FRM and JSF conducted the development of search strategies, selection procedure, data extraction, data synthesis, and analysis. EVP contributed to the database organization and data extraction. SNH contributed to the critical review and writing of this manuscript. All authors participated in the discussions, result interpretation, and approved the final version of manuscript for submission.


FRM was supported by the Coordination for the Improvement of Higher Education Personnel—CAPES through a doctorate at University of Vale do Rio dos Sinos, Brazil. FRM was also supported by CAPES through a sandwich doctorate fellowship at University of Sydney, Australia (number grant: 88881.134589/2016-01). This systematic review was funded by the National Council for Scientific and Technological Development-CNPQ (number grant: 426720/2016-4). The funders were not involved in the design or conduct of the study, collection, analysis, or interpretation of the data or preparation or approval of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

228_2018_2446_MOESM1_ESM.doc (64 kb)
Appendix 1 (DOC 63 kb)
228_2018_2446_MOESM2_ESM.docx (72 kb)
Appendix 2 (DOCX 72 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Fabiane Raquel Motter
    • 1
    • 2
    Email author
  • Janaína Soder Fritzen
    • 1
  • Sarah Nicole Hilmer
    • 2
  • Érika Vieira Paniz
    • 3
  • Vera Maria Vieira Paniz
    • 1
  1. 1.Postgraduate Program in Collective HealthUniversity of Vale do Rio dos Sinos (UNISINOS)Sao LeopoldoBrazil
  2. 2.Department of Clinical Pharmacology and Aged Care, Kolling InstituteRoyal North Shore Hospital and University of SydneySt LeonardsAustralia
  3. 3.Faculty of Medical SciencesFederal University of Rio Grande do Sul (UFRGS)Porto AlegreBrazil

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