Search Results (352)

Polypharmacy in older adults increases risks of adverse drug reactions (ADRs), hospitalisations, and mortality. Pharmacist-led interventions using validated tools (e.g., STOPP/START, MAI, STOPPFrail) aim to optimise prescribing, yet their impact on clinical and economic outcomes in UK/Ireland health systems remains underexplored. This systematic review aimed to critically assess the impact of pharmacist-led deprescribing interventions on PIP, clinical outcomes, and costs in older adults (≥65 years) across the UK and Ireland. Following PRISMA 2020 guidelines, four databases (PubMed, Scopus, Web of Science, Cochrane Library) were searched for studies (2010–2024). Eligible studies included randomised trials, observational designs, and intervention studies in hospitals, care homes, community pharmacies, and intermediate care settings. Fourteen studies met the inclusion criteria. The risk of bias was assessed using CASP checklists. Narrative syntheses and heat maps summarised the findings. Twelve of fourteen studies reported positive outcomes: reductions in potentially inappropriate medications, ADRs, medication burdens, and falls/fall risks. Medication appropriateness improved significantly in 35% of studies using the MAI. STOPPFrail reduced PIMs in care homes, while the MAI enhanced complex hospital reviews. Community interventions improved adherence and reduced the use of fall risk drugs. No studies demonstrated a reduction in hospitalisations, mortality, or the length of stays. Economic analyses showed mixed cost-effectiveness. Key barriers included low uptake of pharmacist recommendations and short follow-up periods. Pharmacist-led interventions have significantly improved the prescribing quality and reduced medication-related risks, but they fail to impact hospitalisations or mortality due to implementation gaps. Context-specific tools and policy reforms—including expanded pharmacist roles and electronic decision support—are critical for sustainability. Future research should focus on long-term outcomes, cost-effectiveness, and multidisciplinary integration. Full article

Background: Antimicrobial stewardship programs (ASPs) are essential for promoting the rational use of antibiotics and combating resistance. In South Korea, implementation has recently accelerated, but real-world data on short-term program performance remain limited. This study evaluated the early outcomes of a newly launched ASP at a tertiary hospital. Methods: This retrospective, single-center study analyzed ASP activity from January to April 2025. Interventions included prospective audit and feedback for restricted antibiotics and recommendations for prolonged antibiotic prescriptions (≥14 days). The primary outcome was the monthly rejection rate of restricted antibiotics. Secondary outcomes included days of therapy (DOT) for restricted antibiotics and the acceptance rate of interventions for prolonged prescriptions. Results: The monthly rejection rate of restricted antibiotics remained stable between 3.65% and 4.68%. Although the DOT values did not show statistical significance, they demonstrated a moderate inverse correlation with the rejection rate (Pearson’s r = –0.868, p = 0.132). Among 826 prolonged prescriptions, 513 (62.1%) received ASP intervention. Acceptance of recommendations increased over time, from 67.0% in January to 82.5% in April. Interventions were primarily based on insufficient evidence of infection or inappropriate antibiotic selection. Conclusions: The newly implemented ASP demonstrated feasibility and early impact in improving antibiotic oversight. Despite the short observation period, the findings suggest a positive influence on prescribing practices. Longer-term studies are needed to evaluate sustained clinical outcomes and broader applicability in diverse healthcare settings. Full article

Recent advances in microbiome research have highlighted the oral cavity as a complex and dynamic ecosystem, home to over 700 microbial species that play critical roles in both oral and systemic health. The oral microbiota not only maintains local tissue homeostasis but also serves as a reservoir for antimicrobial resistance (AMR) genes, contributing to the global spread of resistance. Frequent and sometimes inappropriate antibiotic use in dental practice, along with exposure to antiseptics and biocides, drives the emergence and horizontal transfer of resistance determinants within oral biofilms. This review synthesizes current knowledge on the molecular mechanisms and ecological drivers of AMR in the oral microbiome, emphasizing the clinical implications of dysbiosis and drug-resistant infections. The authors advocate for the development of dental clinical guidelines tailored to the unique characteristics of the oral microbiota, focusing on personalized therapy through molecular diagnostics, standardized AMR risk assessment, and the integration of non-antibiotic strategies such as probiotics and photodynamic therapy. Continuous education in antimicrobial stewardship and the implementation of oral-specific AMR surveillance is also highlighted as an essential component of effective resistance management. To support rational prescribing, a dedicated mobile application has been developed, leveraging microbiota data and resistance profiles to guide evidence-based, targeted therapy and reduce unnecessary antibiotic use. Collectively, these strategies aim to preserve antibiotic efficacy, ensure patient safety, and promote sustainable infection management in the dental field. Full article

Background/Objectives: Antibiotic use is common among hospitalized pediatric patients. However, inappropriate use, including excessive use of Watch antibiotics, can contribute to antimicrobial resistance, adverse events, and increased healthcare costs. Consequently, there is a need to continually assess their usage among this vulnerable population. This was the objective behind this study. Methods: The medical records of all pediatric patients (under 12 years) admitted and treated with antibiotics at a Ghanaian Teaching Hospital between January 2022 and March 2022 were extracted from the hospital’s electronic database. The prevalence and appropriateness of antibiotic use were based on antibiotic choices compared with current guidelines. Influencing factors were also assessed. Results: Of the 410 admitted patients, 319 (77.80%) received at least one antibiotic. The majority (68.65%; n = 219/319) were between 0 and 2 years, and males (54.55%; n = 174/319). Ceftriaxone was the most commonly prescribed antibiotic (20.69%; n = 66/319), and most of the systemic antibiotics used belonged to the WHO Access and Watch groups, including a combination of Access and Watch groups (42.90%; n = 136/319). Neonatal sepsis (24.14%; n = 77/319) and pneumonia (14.42%; n = 46/319) were the most common diagnoses treated with antibiotics. Antibiotic appropriateness was 42.32% (n = 135/319). Multivariate analysis revealed ceftriaxone prescriptions (aOR = 0.12; CI = 0.02–0.95; p-value = 0.044) and surgical prophylaxis (aOR = 0.07; CI = 0.01–0.42; p-value = 0.004) were associated with reduced antibiotic appropriateness, while a pneumonia diagnosis appreciably increased this (aOR = 15.38; CI = 3.30–71.62; p-value < 0.001). Conclusions: There was high and suboptimal usage of antibiotics among hospitalized pediatric patients in this leading hospital. Antibiotic appropriateness was influenced by antibiotic type, diagnosis, and surgical prophylaxis. Targeted interventions, including education, are needed to improve antibiotic utilization in this setting in Ghana and, subsequently, in ambulatory care. Full article

Background and objectives: Life expectancies have increased globally, including in Romania, leading to an aging population and thus increasing the burden of chronic diseases. Over 80% of individuals over 65 have more than three chronic conditions, with many exceeding ten and often requiring multiple medications and supplements. This widespread polypharmacy raises concerns about drug interactions, side effects, and inappropriate prescribing. This review examines the impact of polypharmacy in older adult patients, focusing on the physiological changes affecting drug metabolism and the potential risks associated with excessive medication use. Special attention is given to proton pump inhibitors (PPIs), a commonly prescribed drug class with significant benefits but also risks when misused. The aging process alters drug absorption and metabolism, necessitating careful prescription evaluation. Methods: We conducted literature research on polypharmacy and PPIs usage in the older adult population and the risk associated with this practice, synthesizing 217 articles within this narrative review. Results: The overuse of medications, including PPIs, may lead to adverse effects and increased health risks. Clinical tools such as the Beers criteria, the STOPP/START Criteria, and the FORTA list offer structured guidance for optimizing pharmacological treatments while minimizing harm. Despite PPIs’ well-documented safety and efficacy, inappropriate long-term use has raised concerns in the medical community. Efforts are being made internationally to regulate their consumption and reduce the associated risks. Conclusions: Physicians across all specialties must assess the risk–benefit balance when prescribing medications to older adult patients. A personalized treatment approach, supported by evidence-based prescribing tools, is essential to ensure safe and effective pharmacotherapy. Addressing inappropriate PPI use is a priority to prevent potential health complications. Full article

Background: Among all ambulatory antibiotic prescriptions, about 20% are non-visit-based (ordered outside of an in-person clinical encounter), and about 30% are not associated with an infection-related diagnosis code. Objective/Methods: To identify the rationale for ambulatory antibiotic prescribing, we queried the electronic health record (EHR) of a single, large health system in the Midwest United States to identify all oral antibiotics prescribed from November 2018 to February 2019 and examined visit, procedure, lab, department, and diagnosis codes. For the remaining antibiotic prescriptions—mostly non-visit-based, no-infectious-diagnosis-documented—we randomly selected and manually reviewed the EHR to identify a prescribing rationale and, if none was present, surveyed prescribers for their rationale. Results: During the study period, there were 47,619 antibiotic prescriptions from 1177 clinicians to 41,935 patients, of which 2608 (6%) were eligible non-visit-based, no-infectious-diagnosis-documented. We randomly selected 2298. There was a documented rationale for 2116 (92%) prescriptions. The most common documented reasons—not mutually exclusive—were patient-reported symptoms (71%), persistence of symptoms after initial management (18%), travel (17%), and responding to lab or imaging results (11%). We contacted 160 clinicians who did not document any prescribing rationale in the EHR and received responses from 62 (39%). Clinicians’ stated reasons included upcoming or current patient travel (19%), the antibiotic was for the prescriber’s own family member (19%), or the clinician made a diagnosis but did not document it in the EHR (18%). Conclusions: Non-visit-based, no-infectious-diagnosis-documented antibiotic prescriptions were most often in response to patient-reported symptoms, though they also occur for a variety of other reasons, some problematic, like in the absence of documentation or for a family member. Full article

Background: There is limited published evidence on the prevalence of potentially inappropriate prescribing of medicines in relation to kidney function in older Australians, particularly those with dementia. Objectives: To examine the prevalence, temporal trends and factors associated with potentially inappropriate prescribing of renally-dependent medicines in patients with dementia, using Australian general practice data. Methods: This comparative study was reported in accordance with the STROBE guidelines for cohort studies. Retrospective analyses of the National Prescribing Service (NPS) MedicineInsight dataset were performed to determine the proportion of patients aged ≥ 65 years with a recorded diagnosis of dementia, along with matched controls, who had potentially inappropriate prescribing based on their estimated glomerular filtration rate (eGFR) during the study period (2011–2020). Each patient was included only once throughout the study. Potentially inappropriate prescribing was evaluated for 33 commonly used medicines, using the Cockcroft-Gault equation for estimated creatinine clearance or eGFR, in accordance with the guidelines from the Australian Medicines Handbook (AMH). Each patient’s medicines were included if they were prescribed within 180 days after the most recent recorded lowest eGFR value for the patient. Medicines having prescribed doses exceeding those recommended for an individual’s renal function were classified as ‘inappropriate dosage’, while those whose use was advised against were labelled ‘contraindicated’. Both categories were regarded as inappropriate prescriptions. Descriptive statistics were used to summarise patient characteristics and medication use. Temporal trends were displayed in graphs, with statistical significance determined using the Cochran-Armitage test. Binary logistic regression models were used to examine the associations between sociodemographic and clinical factors and the prescribing of medicines inconsistent with AMH guidelines. Results: The unmatched cohorts included 33,101 patients, comprising 4092 with dementia and 29,009 without. Among them, 58.4% were female, and the overall median age was 82 years [interquartile range (IQR): 77–87]. After propensity score matching, there were 4041 patients with dementia and 8031 without dementia. Over the study period, potentially inappropriate prescribing increased slightly, but insignificantly, in both groups of patients; the prevalence of inappropriate use of at least one of the 33 drugs of interest rose from 6.5% (95% CI 4.5–9.1%) in 2011 to 8.9% (95% CI 6.0–12.7%; p for trend: 0.966) in 2020 in the dementia group, and 9.2% (95% CI 8.0–10.5%) to 11.1% (95% CI 10.3–12.0%; p for trend: 0.224) in the matched controls. Over the ten-year period, approximately 9.3% (377) of patients with dementia in the matched cohort received at least one potentially inappropriate prescription. Among these, 154 (40.8%) were for contraindicated medicines, and 223 (59.1%) were for inappropriate doses based on renal function. Among patients with dementia in the matched cohort, fenofibrate, nitrofurantoin, and moxonidine were the most frequently prescribed medicines at doses inconsistent with AMH guidelines. In the unmatched dementia cohort, potentially inappropriate prescribing was not significantly associated with demographic characteristics or most comorbidities; however, it occurred more frequently in patients with an eGFR below 30 mL/min/1.73 m² or those with concomitant diabetes. Conclusions: Positively, the prevalence of potentially inappropriate prescribing of renally-dependent medicines in primary care patients with dementia in Australia was similar to their matched controls. However, there was room for improvement in the prescribing of these drugs in both patients with and without dementia. Full article

Background/Objectives: Hepatic clearance is important in determining clinical drug administration strategies. Achieving accurate hepatic clearance predictions through in vitro-to-in vivo extrapolation (IVIVE) relies on appropriate model selection, which is a critical step. Although numerous models have been developed to estimate drug dosage, some may fail to predict liver drug clearance owing to inappropriate hepatic clearance models during IVIVE. To address this limitation, an in silico-based model selection approach for optimizing hepatic clearance predictions was introduced in a previous study. The current study extends this strategy by verifying the accuracy of the selected models using ex situ experimental data, particularly for drugs whose model choices are influenced by protein binding. Methods: Commonly prescribed drugs were classified according to their hepatic extraction ratios and protein-binding properties. Building on previous studies that employed multinomial logistic regression analysis for model selection, a three-phase classification method was implemented to identify five representative drugs: diazepam, diclofenac, rosuvastatin, fluoxetine, and tolbutamide. Subsequently, an isolated perfused rat liver (IPRL) system was used to evaluate the accuracy of the in silico method. Results: As the unbound fraction increased for diazepam and diclofenac, the most suitable predictive model shifted from the initially preferred well-stirred model (WSM) to the modified well-stirred model (MWSM). For rosuvastatin, the MWSM provided a more accurate prediction. These three capacity-limited, binding-sensitive drugs conformed to the outcomes predicted by the multinomial logistic regression analysis. Fluoxetine was best described by the WSM, which is consistent with its flow-limited classification. For tolbutamide, a representative capacity-limited, binding-insensitive drug, no significant differences were observed among the various models. Conclusions: These findings demonstrate the accuracy of an in silico-based model selection approach for predicting liver metabolism and highlight its potential for guiding dosage adjustments. Furthermore, the IPRL system serves as a practical tool for validating the accuracy of the results derived from this approach. Full article

Background/Objectives: In 2022, over 200 million outpatient antibiotic prescriptions were written in the U.S., with 30% deemed unnecessary. Previous studies have shown that demographic factors, such as age, gender, and race, influence antibiotic prescribing patterns. However, few studies have examined how social determinants of health contribute to health inequities in antibiotic prescribing. This study aims to explore these disparities in Tennessee using IQVIA data. Methods: The Tennessee Department of Health conducted a cross-sectional study using the IQVIA LRx and Dx databases, linking prescription data to diagnoses from 2022. Antibiotic prescriptions were categorized into three tiers based on appropriateness. A multivariable logistic regression model assessed factors such as age, gender, insurance type, and social vulnerability index (SVI) on antibiotic prescribing patterns. Results: Of 2,874,505 prescriptions analyzed, 59.3% were classified as inappropriate (Tier 3). Female patients and children were less likely to receive inappropriate antibiotics. Patients in lower SVI areas, indicating less social disadvantage, had lower odds of receiving unnecessary prescriptions. Medicaid and Medicare Part D beneficiaries had higher odds of receiving inappropriate antibiotics compared to those with private insurance. Conclusions: This study highlights significant health disparities in outpatient antibiotic prescribing in Tennessee. Male patients, older adults, and individuals in socioeconomically vulnerable areas are more likely to receive inappropriate prescriptions. These findings stress the need for targeted public health interventions to reduce unnecessary antibiotic use and address underlying health inequities, ultimately improving healthcare outcomes and reducing antimicrobial resistance. Full article

Introduction: The consumption of systemic antifungals is on the rise. However, a significant proportion of systemic antifungal prescriptions is inappropriate. Inappropriately prescribed antifungals are problematic, but there has been minimal emphasis on ensuring the appropriate prescription of systemic antifungals. Local studies regarding the patterns and appropriateness of antifungal prescriptions are also lacking. Materials and Methods: In this retrospective, single-centre, observational study, every in-patient prescription order of systemic antifungals in a regional hospital in Hong Kong between 1 May and 31 July 2023 was reviewed via electronic patient records. The appropriateness of a systemic antifungal prescription was assessed by its indication, dosage, duration and antifungal–concomitant drug interactions by a single reviewer. Results: A total of 177 prescriptions orders were collected. Itraconazole, micafungin and fluconazole were the most prescribed systemic antifungals. The haematology team, infectious disease team and ICU were the major systemic antifungal prescribers in this study. The overall appropriateness of systemic antifungal prescriptions was 27.7% (49/177), with an appropriateness of 72.9% (129/177) for indications, 57.1% (101/177) for dosage, 91.5% (162/177) for duration and 71.6% (127/177) for antifungal–concomitant drug interactions. Triazole antifungals had an overall prescription appropriateness of only 15% and were more likely to be prescribed inappropriately than non-triazole antifungals (p < 0.001). Common prescription pitfalls include (i) starting a systemic antifungal for sputum culture that grew Candida spp., (ii) debatable prophylaxis with itraconazole capsules, (iii) overlooking potentially serious antifungal–drug interactions. Conclusions: Inappropriate systemic antifungal prescription is not uncommon in Hong Kong. Establishing an antifungal stewardship programme in public hospitals may be beneficial. Full article

Background: The validated Screening Tool of Older People’s Prescriptions (STOPP) identifies potentially inappropriate prescribing (PIP)—treatments where potential risk outweighs potential benefit. STOPP is particularly important for people aging with HIV and comorbidities, since PIP may exacerbate symptoms and decrease adherence. Methods: We analyzed data from the DC Cohort, a longitudinal cohort of people with HIV (PWH). We applied STOPP criteria to identify PIP among DC Cohort participants aged ≥ 50 years who completed a Patient Reported Outcomes (PROs) survey. All medications prescribed in the 2 years prior to PROs survey completion were considered. Negative binomial models were used to evaluate factors associated with PIP and structural equation modeling was used to evaluate whether symptom burden mediates the relationship between PIP and quality of life. Results: Of 1048 eligible DC Cohort participants, 486 (46%) had at least one PIP. The most common systems implicated were musculoskeletal (23%), analgesic drugs (16%), and the central nervous system (13%). Age, race/ethnicity, HIV transmission factor, social determinants of health, and type of HIV care site were significantly associated with number of PIP in the crude models. In the multivariable model with just demographic variables, the association between age (aIRR: 1.03 (95% CI: 1.02, 1.04)), intravenous drug use (aIRR: 1.68 (95% CI: 1.20, 2.35)), White, non-Hispanic race (aIRR: 0.67 (95% CI: 0.50, 0.92)), site type (aIRR: 0.75 (95% CI: 0.62, 0.92)), and the expected number of PIPs remained significant. In the fully adjusted multivariable model with demographics and SDOH, the association between age, intravenous drug use, White, non-Hispanic race, and expected number of PIPs remained significant. Statistical evidence that symptom burden mediates the relationship between PIP and each of the QOL dimensions was present. Conclusions: Future interventions should work to decrease PIP among these high-risk groups, especially for PIP associated with increased symptom burden. Full article

Objective: The objective of this study was to compare the effectiveness of urea and tolvaptan in the treatment of plasma sodium levels in patients with hypotonic hyponatremia. Methods: This was an observational, longitudinal, and retrospective study including all adult patients who received treatment with urea or tolvaptan for hypotonic hyponatremia from 1 April 2014 to 31 October 2023 at the Department of Internal Medicine, Virgen del Rocío University Hospital, Seville, Spain. Results: Forty-seven (55.3%) patients received urea and 38 (44.7%) tolvaptan. The drugs were prescribed for the treatment of syndrome of inappropriate antidiuresis (SIAD) in 59 (69.4%) patients. The mean blood sodium level at the start of treatment was 123.5 ± 6.2 mEq/L. Overall, 61.7% and 63.2% of patients treated with urea and tolvaptan, respectively, achieved a normal blood sodium level (p = 0.89), although the time to have their sodium levels corrected differed between both groups: 41.7 ± 76 days with urea and 21 ± 23.9 days with tolvaptan (p = 0.038). The following were significant in the multivariate study: Initial sodium value (p = 0.037), absolute sodium improvement (p = 0.041), and percentage sodium improvement (p = 0.033). Among patients with SIAD, 69.5% achieved a normal sodium level; this figure was 45.5% for patients with heart failure. Three patients reported side adverse events in the urea group and none in the tolvaptan group. Conclusions: Our data, reflecting real-world practice and follow-up of patients with hypotonic hyponatremia, suggest that both urea and tolvaptan are safe, well-tolerated, and have a similar effectiveness in correcting blood sodium levels in patients with hypotonic hyponatremia, overall and secondary to SIAD, though treatment with tolvaptan achieved this goal earlier than urea. Full article

Background: Antimicrobial resistance is a growing global health threat, with antibiotic misuse in pediatric populations being a significant contributing factor. In Romania, antibiotic consumption and resistance rates are among the highest in Europe. Objective: To assess Romanian parents’ knowledge, attitudes, and practices regarding antibiotic use in children, and to identify key misconceptions and behavioral risks contributing to inappropriate antibiotic use. Methods: A cross-sectional survey was conducted among 400 parents of hospitalized children in a pediatric department in Romania. Participants completed a 15 item structured questionnaire. Data were analyzed using descriptive statistics, chi-square tests, and binary logistic regression to examine associations and control for potential confounding effects between education level, residential environment, and parental misconceptions regarding antibiotic use. Results: Among the 400 surveyed caregivers, 86% (n = 344) held at least one misconception regarding antibiotic use. Additionally, 42.5% (n = 170) of participants reported that they had never heard of the concept of antibiotic resistance. Misconceptions were significantly more prevalent among individuals with lower levels of education and those residing in rural areas (p < 0.001). While 89.8% (n = 359) stated that they had never administered antibiotics to their children without a physician’s recommendation, a separate subset of 28% (n = 112) acknowledged that they had asked a doctor to prescribe antibiotics for their child. Moreover, 23.3% (n = 93) reported seeking a second medical opinion when antibiotics were not initially prescribed. Conclusions: Despite high adherence to medical advice, widespread misconceptions persist. These findings highlight the need for targeted, population-specific educational interventions to promote rational antibiotic use and address AMR in high-burden settings like Romania. Full article

Inappropriate prescription patterns and polypharmacy are critical challenges facing the optimal management of schizophrenia patients, especially in regard to patient safety. Background/Objectives: The purpose of this study was to examine the relationship between patient safety and the existence of incorrect prescription patterns and/or polypharmacy in the medications prescribed to individuals with schizophrenia. This issue is addressed in a broad context, highlighting the purpose of this study. Methods: A cross-sectional study was adopted, involving a prospective analysis of the prescriptions of schizophrenia patients receiving treatment. Prescription patterns deemed inappropriate were evaluated based on evidence-based guidelines. Antipsychotic maximum allowable daily doses were calculated using the British National Formulary Maximum Daily Dose (BNFmax), an online tool. Patient safety outcomes were assessed using the Glasgow Antipsychotic Side-effect Scale (GASS). Results: A total of 198 patients diagnosed with schizophrenia and receiving treatment consented to participate in the GASS survey. A total of 116 (58.6%) males participated. The mean age of patients was 40.1 (±12.7). Thirty-one (66.2%) reported mild side effects, while 67 (33.8%) reported moderate side effects. Polypharmacy was detected in 103 (52%) patients’ prescriptions. The correlation between GASS and BNFmax was positive and statistically significant (p < 0.001). The elevation in GASS score was associated with polypharmacy prescriptions (OR 3.21; 95% CI 1.64–6.29), the presence of first-generation antipsychotics (FGAP) (OR 2.79; 95% CI 0.236–5.951), any combination of antipsychotics containing haloperidol (OR 3.22; 95% CI 1.11–9.32), and olanzapine (OR 3.46; 95% CI 1.36–8.79). Conclusions: The safety of patients with schizophrenia has been proven to be impacted by the improper use of psychotropic drugs. Following evidence-based guidelines is a cornerstone to ensuring optimal, effective, and safe patient treatment plans. Full article

Background: Potentially inappropriate medications (PIMs) and potential prescription omissions (PPOs) have been widely explored, but few studies focused on patients aged 75 years and over. This study was planned to explore the demographic and clinical characteristics of the older patients admitted to Units for Integrated Continuous Care, and to assess the prevalence and potential predictors of PIMs and PPOs. Methods: An observational, retrospective, and multicenter study was performed on 135 patients aged 75 years or older (i.e., 75–84 years and ≥85 years). PIMs and PPOs were investigated by applying the Screening Tool of Older People’s Prescriptions (STOPP) and Screening Tool to Alert to Right Treatment (START) criteria. Results: The oldest-old patients (≥85 years) were less likely to come from a hospital, had fewer daily medications and a lower number of oral doses, but they presented a higher Charlson Comorbidity Index, were more dependent on activities of daily living, and were less obese than those aged 75–84 years. Results showed a high prevalence of PIMs and PPOs in both age groups. The more common PIMs and PPOs were the same in both age groups. The oldest-old patients who suffered falls were more likely to have a prescription omission of vitamin D supplements. The PIM index was not significantly different between age groups but was higher in the oldest-old group. Conclusions: Patients with a higher number of prescriptions had a higher risk of PIMs. Regarding PPOs, male gender and fall risk were predictors in the youngest group, while the number of comorbidities was significantly associated with PPOs in the oldest group. This study supports the usefulness of the STOPP/START criteria to identify PIMs and PPOs in these patients, but more research is required to determine the potential adverse outcomes of PIMs and PPOs and their clinical and economic consequences. Full article