Potentially inappropriate medicines for older people: consensus-based lists.

Abstract

Older people, especially with multimorbidity and polypharmacy, are at higher risk of adverse medication outcomes compared with younger adults. To guide safer prescribing for older people, several lists of 'potentially inappropriate medicines' (PIMs lists) have been developed. Prominent PIMs lists include the Beers Criteria (USA) and the Screening Tool of Older People's Prescriptions (STOPP) (Europe). A new Australian PIMs list was published in 2024. PIMs are medicines for which there is evidence or consensus expert opinion that the potential risks usually outweigh the clinical benefits in a specific patient cohort. The Australian PIMs list outlines medicines that should be avoided in all older people, and medicines that should be avoided in certain clinical contexts. It also provides guidance on potentially safer alternatives to the listed medicines. Importantly, medicines included in PIMs lists are not always inappropriate. There may be clinical scenarios where a PIM is appropriate for an individual patient (hence the term potentially inappropriate). Prescribing decisions should always be individualised, considering the patient's clinical status and goals of care.