Barriers to appropriate prescribing in older adults with multimorbidity: A modified Delphi study

Abstract

Potentially inappropriate prescribing (PIP) in older adults is a rising concern around the world, as life expectancies are increasing and people are living longer with multimorbidity. 1 Inappropriate prescribing can be partly attributed to polypharmacy, which is commonly defined as taking five or more medications daily. 2 Although there is variability in the definition of polypharmacy in the literature, polypharmacy is unavoidable among older adults as they are more likely to have comorbid or multimorbid conditions. Polypharmacy increases the risk of one being prescribed inappropriate medications with risks outweighing their benefits, which could result in adverse drug events, drug interactions, decline in functional status, cognitive impairment, falls, urinary incontinence, and reduced nutritional status. 3 A systematic review on the prevalence of potentially inappropriate medication use in older inpatients with or without cognitive impairment found the range to be from 0.6% to 88.5% when using clinical tools such as Beers criteria and Screening Tool of Older Persons' Prescriptions (STOPP). 4 With trends in polypharmacy and PIP expected to continue rising among older adults, 1,5 it is crucial to