Identifying inappropriate prescribing for older people

Older people are at risk of polypharmacy, inappropriate prescribing and adverse drug reactions. Reasons include comorbidities, altered pharmacodynamics and pharmacokinetics, and limited evidence to guide drug therapy decisions, especially for people aged > 75 years. Tools to assist with identifying inappropriate prescribing for older people have been developed. The most well known is the Beers criteria, a list of medications that an expert panel agreed should usually be avoided. Criticism of the Beers criteria and limited applicability outside of North America, led to the development of other tools and a major revision of the Beers criteria in 2012. Since 2008, the Screening Tool of Older Persons' Prescriptions and the Screening Tool to Alert doctors to Right Treatment have gained popularity. Australian indicators and electronic decision support systems have also been developed. This article provides an overview of the tools for identifying (and avoiding) inappropriate prescribing and their application in clinical practice and research.