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Identifying potentially inappropriate prescribing in older people with dementia: a systematic review

Hukins, Deborah; Macleod, Una; Boland, Jason W.


Deborah Hukins

Jason W. Boland


Purpose: Older people with dementia are at risk of adverse events associated with potentially inappropriate prescribing. Aim: to describe (1) how international tools designed to identify potentially inappropriate prescribing have been used in studies of older people with dementia, (2) the prevalence of potentially inappropriate prescribing in this cohort and (3) advantages/disadvantages of tools Methods: Systematic literature review, designed and reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). MEDLINE, EMBASE, PsychInfo, CINAHL, the Cochrane Library, the Social Science Citation Index, OpenGrey, Base, GreyLit, Mednar and the National Database of Ageing Research were searched in April 2016 for studies describing the use of a tool or criteria to identify potentially inappropriate prescribing in older people with dementia. Results: Three thousand three hundred twenty-six unique papers were identified; 26 were included in the review. Eight studies used more than one tool to identify potentially inappropriate prescribing. There were variations in how the tools were applied. The Beers criteria were the most commonly used tool. Thirteen of the 15 studies using the Beers criteria did not use the full tool. The prevalence of potentially inappropriate prescribing ranged from 14 to 74% in older people with dementia. Benzodiazepines, hypnotics and anticholinergics were the most common potentially inappropriately prescribed medications. Conclusions: Variations in tool application may at least in part explain variations in potentially inappropriate prescribing across studies. Recommendations include a more standardised tool usage and ensuring the tools are comprehensive enough to identify all potentially inappropriate medications and are kept up to date.


Hukins, D., Macleod, U., & Boland, J. W. (2019). Identifying potentially inappropriate prescribing in older people with dementia: a systematic review. European Journal of Clinical Pharmacology, 75(4), 467-481.

Journal Article Type Review
Acceptance Date Dec 13, 2018
Online Publication Date Jan 4, 2019
Publication Date Apr 9, 2019
Deposit Date Jan 7, 2019
Publicly Available Date Jan 10, 2019
Journal European Journal of Clinical Pharmacology
Print ISSN 0031-6970
Electronic ISSN 1432-1041
Publisher Springer (part of Springer Nature)
Peer Reviewed Peer Reviewed
Volume 75
Issue 4
Pages 467-481
Keywords Potentially inappropriate prescribing; Dementia; Older people; Polypharmacy
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© The Author(s) 2019
This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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