J. Pharm. Pharmacogn. Res., vol. 13, no. 6, pp. 1797-1818, Nov-Dec 2025.
DOI: https://doi.org/10.56499/jppres25.2487_13.6.1797
Review
Explicit criteria for potentially inappropriate medications in older adults: A comprehensive systematic review
[Criterios explícitos para medicamentos potencialmente inapropiados en adultos mayores: Una revisión sistemática integral]
Eliezer Alemán-Fernández1*, Dany Siverio-Mota2, Liliana Vicet-Muro2, Antonio J. Braza3, Montserrat Viñas-Bastart3, Pilar Modamio3, René Delgado-Hernández3,4**
1Municipal Directorate of Pharmacy, Provincial Directorate of Public Health, Santa Clara, Villa Clara, Cuba.
2Department of Pharmacy. Central University of Las Villas. Villa Clara, Cuba.
3Clinical Pharmacy and Pharmaceutical Care Unit. Department of Pharmacy and Pharmaceutical Technology, and Physical Chemistry. Faculty of Pharmacy and Food Sciences. University of Barcelona. Av. Joan XXIII, 27-31, 08028 Barcelona, Spain.
4Institute of Pharmacy and Food. University of Havana. Havana, Cuba.
*E-mail: *eliezerfernandez1975@gmail.com, **renedelgado@ub.edu
Abstract
Context: Potentially inappropriate medications (PIMs) refer to the use of a medication whose risks outweigh the potential benefits in older adults, especially when other effective alternatives are available.
Aims: To identify and analyze explicit criteria developed for detecting PIMs in older adults, highlighting methodological approaches and pharmacological classifications.
Methods: A comprehensive literature search was conducted across seven databases from January 1990 to December 2024, following the PRISMA 2020 guidelines. Criteria developed using expert consensus or evidence-based processes were included.
Results: Out of 3,119 articles, 68 met the inclusion criteria. The Beers and STOPP/START tools were most frequently cited. The Delphi method was the predominant approach for validating the selected tools (73.53%). Commonly flagged medications included tricyclic antidepressants, NSAIDs, and benzodiazepines.
Conclusions: Numerous validated tools exist, although variations in validation methods and drug classification were observed. A global update and harmonization of explicit criteria are necessary for improved geriatric pharmacotherapy.
Keywords: Beers criteria; Delphi method; deprescribing tools; older adults; potentially inappropriate medications; STOPP START criteria.
Resumen
Contexto: La medicación potencialmente inapropiada (PIMs por sus siglas en inglés) se refiere al uso de un medicamento cuyos riesgos superan los beneficios potenciales en adultos mayores, especialmente cuando hay otras alternativas efectivas disponibles.
Objetivos: Identificar y analizar los criterios explícitos desarrollados para la detección de PIMs en adultos mayores, destacando los enfoques metodológicos y las clasificaciones farmacológicas.
Métodos: Se realizó una revisión sistemática exhaustiva utilizando siete bases de datos desde enero 1990 hasta diciembre 2024 siguiendo las directrices PRISMA 2020. Se incluyeron criterios desarrollados mediante consenso de expertos o procesos basados en la evidencia.
Resultados: De 3119 publicaciones, se incluyeron 68 herramientas. Los criterios de Beers y STOPP/START fueron los más citados. Para la validación de las herramientas seleccionadas predominó el método Delphi (73.53%). Los antidepresivos tricíclicos, NSAIDs y las benzodiazepinas fueron los medicamentos más señalados.
Conclusiones: Existen numerosas herramientas validadas, aunque fueron observadas variaciones en los métodos de validación y la clasificación de los medicamentos. Es necesaria una actualización y armonización global de los criterios explícitos para mejorar la farmacoterapia geriátrica.
Palabras Clave: adulto mayor; criterios de Beers; criterios STOPP START; herramientas de deprescripción; medicamentos potencialmente inapropiados; método Delphi.
Citation Format: Alemán E, Siverio D, Vicet L, Braza A, Viñas M, Modamio P, Delgado R (2025) Explicit criteria for potentially inappropriate medications in older adults: A comprehensive systematic review. J Pharm Pharmacogn Res 13(6): 1797–1818. https://doi.org/10.56499/jppres25.2487_13.6.1797
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