Association between Potentially Inappropriate Medication and Mortality Risk in Older Adults: A Systematic Review and Meta-Analysis.

Objectives: This study aimed to comprehensively assess the association between potentially inappropriate medication (PIM) and mortality risk in older adults through systematic review and meta-analysis.

Design: Systematic review and meta-analysis.

Setting And Participants: Adults aged 60 years and older with PIM use.

Methods: A systematic search was conducted in PubMed, Web of Science, Cochrane Library, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and China National Knowledge Infrastructure (CNKI) databases up to July 23, 2024. Studies assessing the association between PIM and the risk of death in older adults with sufficient data for meta-analysis were included. Effect sizes were combined using a random-effects model, and heterogeneity was systematically explored.

Results: A total of 44 studies involving 2,191,651 older adults were included. The overall PIM incidence was 45.7% (95% CI, 34.5%-57.0%). Meta-analysis revealed a combined odds ratio (OR) of 1.28 (95% CI, 1.20-1.36) for the association between PIM and increased risk of death. In addition, antipsychotics were associated with a higher risk of death (OR, 2.19; 95% CI, 1.75-2.73), as were anticholinergics (OR, 1.52; 95% CI, 1.23-1.88). Subgroup analyses indicated the association between PIM and death risk was particularly significant in Asia and Oceania, with a weaker association in North America and Europe. The strongest associations were found in individuals aged 70 years and older. The Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) criteria had stronger associations than other diagnostic criteria for PIM.

Conclusions And Implications: This study confirms a significant association between PIM and mortality risk in older adults, highlighting the need for rational medication use. Clinicians should carefully assess medications in treatment plans. Future research should enhance assessment tools and investigate the impact of PIM on health outcomes to improve medication management.