Prevalence and Predictors of Potentially Inappropriate Medication Use in Older Outpatients: A Cross-Sectional Study Using the 2023 Beers Criteria at a Tertiary Care Clinic

Older adults with psychiatric conditions are at elevated risk for potentially inappropriate medication (PIM) use due to multimorbidity, polypharmacy, and cognitive vulnerability. PIMs increase the risk of adverse drug reactions (ADRs), especially in low-resource settings where clinical pharmacy support may be limited. The aim of this study was to determine the prevalence, types, and predictors of PIM use among older psychiatric outpatients using the 2023 American Geriatrics Society (AGS) Beers criteria. This cross-sectional study was conducted at the psychiatry outpatient department of a tertiary care hospital in India from December 2021 to March 2023. Older adults patients (aged ≥65 years) prescribed at least one psychotropic medication were assessed for PIM use based on the Beers criteria. Demographic, clinical, and prescription data were analyzed, and logistic regression was used to identify predictors of PIM use. Among 364 patients (median age 69 years), the prevalence of PIM use was 88.7%. A total of 692 PIM instances were identified, with benzodiazepines (22.1%), selective serotonin reuptake inhibitors (SSRIs, 20.2%), and antipsychotics (13.6%) being most common. Polypharmacy (≥5 drugs) was present in 32.15% of patients. Anticholinergic burden (ACB) score ≥3 (adjusted odds ratio AOR 3.55, 95% CI 1.12–11.31; p = 0.032) and potential drug–drug interactions (AOR 3.73, 95% CI 1.16–12.03; p = 0.028) were significantly associated with PIM use. Although ADRs (e.g., sedation, hyponatremia) were more frequent in those with PIMs, their association did not reach statistical significance (AOR 7.08; p = 0.071). PIM use is highly prevalent among older adults attending a tertiary care psychiatric clinic, with benzodiazepines, SSRIs, and antipsychotics being the most frequently prescribed. A high anticholinergic burden and potential drug–drug interactions were significant predictors of PIM use, whereas polypharmacy was not independently associated in multivariate analysis. Targeted interventions, including medication review and deprescribing strategies, are essential to enhance prescribing safety and reduce adverse drug-related outcomes. As people age, they are more likely to be prescribed multiple medications, some of which may be harmful or unnecessary. These are called potentially inappropriate medications (PIMs). Older adults with mental health conditions are especially at risk because they often take several medications that act on the brain. In this study, we looked at 364 older adults visiting the psychiatry outpatient department of a hospital in India. We checked their prescriptions using a well-known safety checklist called the 2023 Beers Criteria, which helps doctors identify medications that may be risky for older people. We found that nearly 9 out of 10 patients (88.7%) were taking at least one potentially inappropriate medicine. The most common types were sleeping pills like clonazepam, antidepressants like escitalopram, and antipsychotic drugs. Many patients were also taking medications that could interact with each other or had high levels of drugs that can cause confusion and memory problems. Some patients experienced side effects such as drowsiness, tremors, or low sodium levels, which could be linked to the medications they were taking; however, the study could not confirm that these medicines directly caused the side effects. Our findings show that older adults with mental health issues are often prescribed medicines that may not be safe, especially in settings with fewer resources. To make prescribing safer, we recommend regular medication reviews, reducing unnecessary medicines, and improving training for doctors in elderly care. These steps can help protect older patients from avoidable harm.