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Objective: To describe the psychotropic drug deprescription process in older patients of a geriatric psychiatry outpatient clinic. Methods: We conducted a quasi-experimental study of people aged ≥ 60 years who were treated at Hospital São Lucas' Geriatric Psychiatry Outpatient Clinic, which is affiliated with Pontifícia Universidade Católica do Rio Grande do Sul, Brazil. Data on 150 older people were collected from March 2021 to August 2022 and were evaluated by the pharmacists. The inclusion criteria were age ≥ 60 years, being a patient of the hospital's Geriatric Psychiatry Outpatient Clinic, use of at least one psychotropic drug, and agreeing to participate in the study. Those unable to report their medications and those who only came to the first appointment were excluded. Results: Overall, deprescription of at least one psychotropic drug was indicated in 61.3% (n = 92) of the participants, and it was effectively implemented in 68.5% (n = 63) of this group. Deprescribing, which was more frequent in the youngest age group (60­69 years) (p = 0.049), was indicated for 37.4% (n = 136) of psychotropic drugs, 67.6% (n = 92) of which were effectively deprescribed. The main classes indicated for deprescription were hypnotics and sedatives (90.0%; n = 18) and anxiolytics (73.3%; n = 11). Conclusions: At least 1 psychotropic drug was indicated for deprescription in the majority of the patients, and in most cases it was effectively implemented. One-third of the prescribed psychotropic drugs were indicated for deprescription, and more than half were successfully deprescribed. (AU)

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OBJECTIVES: Patients with life-limiting illnesses are prone to unnecessary polypharmacy. Deprescribing tools may contribute to minimizing negative outcomes. Thus, the aims of the study were to identify validated instruments for deprescribing inappropriate medications for patients with palliative care needs and to assess the impact on clinical, humanistic, and economic outcomes. METHODS: A systematic review was conducted in LILACS, PUBMED, EMBASE, COCHRANE, and WEB OF SCIENCE databases (until May 2021). A manual search was performed in the references of enrolled articles. The screening, eligibility, extraction, and bias risk assessment were carried out by 2 independent researchers. Experimental and observational studies were eligible for inclusion. RESULTS: Out of the 5791 studies retrieved, after excluding duplicates (n = 1050), conducting title/abstract screening (n = 4741), and full reading (n = 41), only 1 study met the inclusion criteria. In this included study, a randomized controlled trial was conducted, which showed a high level of bias risk overall. Adults 75 years or older (n = 130) with limited life expectancy and polypharmacy were allocated to 2 groups [intervention arm (deprescribing); and control arm (usual care)]. Deprescribing was performed with the aid of the STOPPFrail tool. The mean number of inappropriate medications and monthly medication costs were significantly lower in the intervention arm. No statistically significant differences were found in terms of unscheduled hospital presentations, falls, fractures, mortality, and quality of life. CONCLUSIONS: Despite the availability of several instruments to support deprescribing in patients with palliative care needs, only 1 of them has undergone validation and robust assessment for effectiveness in clinical practice. The STOPPFrail tool appears to reduce the number of inappropriate medications for older people with limited life expectancy (and probably palliative care needs) and decrease the monthly costs of pharmacotherapy. Nevertheless, the impact on patient safety and humanistic outcomes remain unclear.

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Objectives Patients with life-limiting illnesses are prone to unnecessary polypharmacy. Deprescribing tools may contribute to minimizing negative outcomes. Thus, the aims of the study were to identify validated instruments for deprescribing inappropriate medications for patients with palliative care needs and to assess the impact on clinical, humanistic, and economic outcomes. Methods A systematic review was conducted in LILACS, PUBMED, EMBASE, COCHRANE, and WEB OF SCIENCE databases (until May 2021). A manual search was performed in the references of enrolled articles. The screening, eligibility, extraction, and bias risk assessment were carried out by 2 independent researchers. Experimental and observational studies were eligible for inclusion. Results Out of the 5791 studies retrieved, after excluding duplicates (n = 1050), conducting title/abstract screening (n = 4741), and full reading (n = 41), only 1 study met the inclusion criteria. In this included study, a randomized controlled trial was conducted, which showed a high level of bias risk overall. Adults 75 years or older (n = 130) with limited life expectancy and polypharmacy were allocated to 2 groups [intervention arm (deprescribing); and control arm (usual care)]. Deprescribing was performed with the aid of the STOPPFrail tool. The mean number of inappropriate medications and monthly medication costs were significantly lower in the intervention arm. No statistically significant differences were found in terms of unscheduled hospital presentations, falls, fractures, mortality, and quality of life. Conclusions Despite the availability of several instruments to support deprescribing in patients with palliative care needs, only 1 of them has undergone validation and robust assessment for effectiveness in clinical practice. The STOPPFrail tool appears to reduce the number of inappropriate medications for older people with limited life expectancy (and probably palliative care needs) and decrease the monthly costs of pharmacotherapy. Nevertheless, the impact on patient safety and humanistic outcomes remain unclear.

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BACKGROUND: Potentially inappropriate medication use is prevalent among older adults in primary care, leading to increased morbidity, adverse drug reactions, hospitalizations, and mortality. This study aimed to develop and validate a tool for identifying PIMs in older adults within the primary care setting. The tool is composed of a list of criteria and was created based on consensus among experts from three Spanish-speaking countries, including two from Latin America. METHODS: A literature review was conducted to identify existing tools, and prescription patterns were evaluated in a cohort of 36,111 older adults. An electronic Delphi method, consisting of two rounds, was used to reach a formal expert consensus. The panel included 18 experts from Spain, Colombia, and Argentina. The content validity index, validity of each content item, and Kappa Fleiss statistical measure were used to establish reliability. RESULTS: Round one did not yield a consensus, but a definitive consensus was reached in round two. The resulting tool consisted of a list of 5 general recommendations per disease, along with 33 criteria related to potential problems, recommendations, and alternative therapeutic options. The overall content validity of the tool was 0.87, with a Kappa value of 0.69 (95% CI 0.64-0.73; Substantial). CONCLUSIONS: The developed criteria provide a novel list that allows for a comprehensive approach to pharmacotherapy in older adults, intending to reduce inappropriate medication use, ineffective treatments, prophylactic therapies, and treatments with an unfavorable risk-benefit ratio for the given condition. Further studies are necessary to evaluate the impact of these criteria on health outcomes.

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Patients with life-limiting illnesses are prone to unnecessary polypharmacy. Deprescribing tools may contribute to minimizing negative outcomes. Thus, the aims of the study were to identify validated instruments for deprescribing inappropriate medications for patients with palliative care needs and to assess the impact on clinical, humanistic, and economic outcomes. Methods A systematic review was conducted in LILACS, PUBMED, EMBASE, COCHRANE, and WEB OF SCIENCE databases (until May 2021). A manual search was performed in the references of enrolled articles. The screening, eligibility, extraction, and bias risk assessment were carried out by 2 independent researchers. Experimental and observational studies were eligible for inclusion. Results Out of the 5791 studies retrieved, after excluding duplicates (n = 1050), conducting title/abstract screening (n = 4741), and full reading (n = 41), only 1 study met the inclusion criteria. In this included study, a randomized controlled trial was conducted, which showed a high level of bias risk overall. Adults 75 years or older (n = 130) with limited life expectancy and polypharmacy were allocated to 2 groups [intervention arm (deprescribing); and control arm (usual care)]. Deprescribing was performed with the aid of the STOPPFrail tool. The mean number of inappropriate medications and monthly medication costs were significantly lower in the intervention arm. No statistically significant differences were found in terms of unscheduled hospital presentations, falls, fractures, mortality, and quality of life. Conclusions Despite the availability of several instruments to support deprescribing in patients with palliative care needs, only 1 of them has undergone validation and robust assessment for effectiveness in clinical practice. The STOPPFrail tool appears to reduce the number of inappropriate medications for older people with limited life expectancy (and probably palliative care needs) and decrease the monthly costs of pharmacotherapy. Nevertheless, the impact on patient safety and humanistic outcomes remain unclear.

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Background Inappropriate use of clonazepam by older adults is associated with cognitive impairment, delirium, and falls. Strategies to optimize its use are important to increase patient safety. Objective To evaluate the feasibility of a clonazepam deprescription protocol in the elderly. Methods This is a quasi-experimental study. Elderly people with chronic use of clonazepam and attended in primary care units in two Brazilian municipalities were selected. A deprescription protocol was used, which included five fortnightly meetings between the older adults and the research team, to reduce the dose by 25%. Patients received instructions on sleep hygiene behaviors and the advantages of clonazepam deprescription; family physicians followed a flowchart for gradual dose reduction. In the 1st and 5th meetings, there were medical appointments for anamnesis and discharge. The monitoring of patients and the application of tests were carried out by the research team. Results Of the 35 elderly people included in the study, 27 reached the end; 81.5% achieved deprescription: 22.2% stopped completely and 59.3% decreased the dose. At the last meeting, 20% of elderly patients reported an increase in blood pressure. Conclusion The high rate of deprescription and the little relevance of clonazepam withdrawal reactions, showed that the use of the protocol was effective. However, the increase in blood pressure and the worsening of sleep quality in the last meeting show the need for adjustment in the last stage of the deprescription process.

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BACKGROUND: As long-term use of benzodiazepines increases, adverse effects also become more frequent, especially in elderly adults. Due the potential of causing dependence, poor patient adherence and a lack of awareness of side effects, deprescription is challenging. OBJECTIVE: This study aimed to identify what are the effective approaches to motivate and promote deprescription of benzodiazepines. METHODS: We used MeSH terms to search in five databases that were MEDLINE, Cochrane CENTRAL, LILACS, SCIELO and Science Direct. Then, we selected articles accordingly to inclusion and exclusion criteria. Risk of bias assessment for randomized controlled trials and prospective interventional studies was made using RoB 2.0 and ROBINS-I tools, respectively. For cohort studies, we used the clarity group by McMaster University tool. RESULTS: Database search retrieved 412 results, and 11 studies were selected for analysis. Interventions focusing on patient education to improve community awareness about deprescription presented better discontinuation rates and more potential on motivating discussions about deprescribing with physicians. Interventions based on counselling by different health professionals were not well evaluated as they presented four of six studies as high, serious or critical risk of bias. CONCLUSIONS: Although the comparison of different strategies was impaired by the high risk of bias in some studies, patient education focused interventions presented good results. Future studies should consider doing a follow-up of 6 months or longer with evaluation of withdrawal symptoms and sleep patterns, inclusion of young adults on the sample and some form of cognitive evaluation that might influence the results of the intervention.

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Prescribing medications involves complex cognitive processes, and mistakes in prescription can cause serious adverse events. Deprescribing is one of the last opportunities to prevent patient harm from the use of drugs that should be avoided, especially among older patients. This viewpoint article aims to discuss the prescription process and some essential concepts, such as polypharmacy, prescription of potentially inappropriate medications, and, particularly, the relevance of deprescribing and its relationship with the appropriate prescription of medications in older people.

A prescrição de medicamentos envolve processos cognitivos complexos e erros na prescrição podem causar eventos adversos graves. A desprescrição é uma das últimas oportunidades de prevenir danos ao paciente decorrentes do uso de medicamentos que devem ser evitados, principalmente entre pacientes mais velhos. Este artigo teve como objetivo discutir o processo de prescrição e alguns conceitos essenciais, como a polifarmácia, a prescrição de medicamentos potencialmente inadequados e, particularmente, a relevância da desprescrição e sua relação com a prescrição adequada de medicamentos em idosos.

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De acuerdo a las estimaciones mundiales, el año 2050, habrá más de 2000 millones de personas mayores (PM) de 60 años. En Chile, la situación no es distinta, el país está envejeciendo y esta situación nos expone a nuevos desafíos. Las PM, suelen presentar una mayor carga de enfermedad con el consiguiente aumento en la utilización de medicamentos para controlar su comorbilidad y multimorbilidad. Esta polifarmacia (uso de 5 o más medicamentos) trae consigo riesgos tales como el aumento de caídas, mayor fragilidad, aumento de los costos, entre otros. Para abordar estos riesgos en las PM, aparece el concepto de deprescripción como la práctica de retiro de medicamentos considerados inapropiados, supervisado por un profesional de la salud con el objetivo de gestionar la polifarmacia y mejorar los resultados clínicos. La deprescripción de medicamentos tales como las benzodiazepinas podrían mejorar la calidad del sueño y la calidad de vida, el retiro de analgésicos antinflamatorios no esteroidales y betabloqueadores disminuyen las caídas entre otros resultados. Esta práctica, debiese plantearse, por ejemplo, cuando los síntomas o síndromes coinciden con los efectos adversos a algunos de los medicamentos, cuando el paciente se encuentra en estadío avanzado de su enfermedad, con extrema fragilidad, con demencia avanzada o en cuidados de fin de vida. A pesar de que cada vez aparece más literatura que muestra la utilidad de deprescribir, queda aún pendiente expandir el conocimiento para generar evidencia de mejor calidad metodológica que oriente en qué escenarios se obtienen los mejores resultados para los pacientes.

According to global estimates, in the year 2050, there will be more than 2000 million older people (OP) of 60 years. In Chile, the situation is no different, the country is aging and this situation exposes us to new challenges. The OP, usually present a greater burden of disease resulting in an increase in the use of medications to control their comorbidity and multimorbility. This polypharmacy (the use of 5 or more drugs) it brings risks such as the increase in falls, greater fragility, increased costs, among others. To address these risks in the OP, the term deprescribing appears as the process of withdrawal of inappropriate medication, supervised by a health care professional with the goal of managing polypharmacy and improve clinical outcomes. Deprescribing medications such as benzodiazepines could improve the quality of sleep and quality of life, the withdrawal of non-steroidal anti-inflammatory analgesics and beta-blockers decrease falls among other results. This practice should arise, for example, when the symptoms or syndromes coincide with adverse effects to some of the medicines, when the patient is in advanced stage of their illness, with extreme fragility, with advanced dementia or end-of-life care. Despite the fact that every time appears more literature that shows the usefulness of deprescribir, to expand the knowledge to generate evidence of better quality that show in which scenarios are obtained the best results for patients.

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Introdução: Algumas alterações fisiológicas que ocorrem no indivíduo idoso favorecem o acúmulo e a intoxicação por medicamentos. Dentre estes, podemos citar a classe dos benzodiazepínicos, medicamentos que, apesar de amplamente prescritos, principalmente para tratamento de distúrbios do sono e ansiedade, são considerados potencialmente inapropriados para o uso em idosos. Portanto, a elaboração de protocolos para desprescrição desses medicamentos é estratégia necessária na gestão do cuidado dos pacientes geriátricos. Objetivo: Elaborar e validar um protocolo de desprescrição do clonazepam para idosos que fazem uso deste medicamento para ansiedade ou insônia. Métodos: Estudo metodológico, desenvolvido em duas etapas, sendo elas a elaboração e a validação do protocolo de desprescrição do clonazepam para idosos que fazem uso desse medicamento para ansiedade ou insônia, excetuando-se aqueles que preenchem os critérios de exclusão. A elaboração do protocolo resultou em três produtos: um fluxograma de desprescrição, um folheto sobre higiene do sono e um folheto contendo os benefícios da desprescrição do clonazepam sob supervisão médica. A validação do protocolo foi realizada por médicos especialistas, por meio da Técnica de Delphi. Já na validação dos folhetos, participaram, além dos especialistas, indivíduos com 60 anos ou mais, de ambos os sexos, que não fizessem uso do clonazepam. A partir dos resultados obtidos, foi analisada a concordância da avaliação por meio do Coeficiente de Validade de Conteúdo (CVC), uma vez que essa ferramenta objetiva medir o grau de concordância dos juízes participantes do processo de validação. Resultados: O fluxograma foi considerado validado após a segunda rodada de avaliação, pois todos os itens avaliados obtiveram CVC igual ou superior a 0,8 nesta rodada. Os folhetos foram considerados validados já na primeira rodada de avaliação, pois todos os itens também obtiveram CVC superior a 0,8 durante esta rodada. Conclusão: Considerando os resultados obtidos, o protocolo se apresenta como uma ferramenta importante ao guiar a conduta médica no processo de desprescrição do clonazepam.

Introduction: Some physiological changes that occur in the elderly individual favor the accumulation and intoxication by drugs. Among these, we can mention the class of benzodiazepines, medicines which, although widely prescribed mainly for the treatment of sleep disorders and anxiety, are considered potentially inappropriate for use in the elderly. Therefore, the elaboration of protocols for the deprescribing of those drugs is a necessary strategy in the management of the care of geriatric patient. Objective: To elaborate and validate a protocol for the Deprescribing of clonazepam for the elderly who use this medication for anxiety or insomnia. Methods: Methodological study, developed in two stages ­ elaboration and validation of the protocol of deprescribing of clonazepam for elderly people who use this medication for anxiety or insomnia, except those who meet the exclusion criteria. The elaboration of the protocol resulted in three products: a flowchart of deprescribing, a leaflet of sleep hygiene, and a leaflet containing the benefits of the clonazepam Deprescribing under medical supervision. The validation of the protocol was performed by medical specialists, through the Delphi Technique. In addition to the specialists, individuals of both sexes, aged 60 years or more who did not use clonazepam, took part in the validation of the leaflets. Based on the results obtained, the agreement of the evaluation was analyzed using the Content Validity Coefficient (CVC), since this tool aims to measure the degree of agreement of the judges participating in the validation process. Results: The flowchart was considered validated after the second round of evaluation, since all items assessed had a CVC equal to or greater than 0.8 in this round. The leaflets were considered validated in the first evaluation round, since all items also obtained CVC greater than 0.8 during this round. Conclusion: Considering the results obtained, the protocol presents itself as an important tool in guiding medical conduct in the process of Deprescribing of clonazepam

Introducción: Algunas alteraciones fisiológicas que ocurren en el individuo mayor favorecen el acumulación y la intoxicación por medicamentos. Entre estas, podemos citar la clase de los benzodiazepínicos, medicamentos que, a pesar de ampliamente prescritos, principalmente para el tratamiento de disturbios del sueño y de la ansiedad, son considerados potencialmente inapropiados si usados por personas mayores. Por lo tanto, la elaboración de protocolos para desprescripción de esos medicamentos son estrategias necesarias en la gestión al cuidado de los pacientes geriátricos. Objetivo: Elaborar y validar un protocolo de desprescripción de clonazepam para mayores que hacen uso de esta medicina para ansiedad o insomnio. Métodos: Estudio metodológico, desarrollado en dos etapas, siendo ellas la elaboración y la validación del protocolo de desprescripción del clonazepam para mayores que hacen uso de ese medicamento para ansiedad o insomnio, exceptuando aquellos que cumplen los criterios de exclusión. La elaboración del protocolo resultó en tres productos: un flujograma de desprescripción, un folleto sobre la higiene del sueño y un folleto conteniendo los beneficios de la desprescripción del clonazepam bajo supervisión médica. La validación del protocolo fue realizada por médicos especialistas, por medio de la Técnica de Delphi. Ya en la validación de los folletos, participaron, además de los especialistas, individuos con 60 años o más, de ambos sexos, que no hiciesen uso de clonazepam. A partir de los resultados obtenidos, fue analizada la concordancia de la evaluación por médio del Coeficiente de Validez de Contenido (CVC), una vez que esa herramienta objetiva medir el grado de concordancia de los jueces partícipes del proceso de validación. Resultados: El flujograma fue considerado validado después de la segunda ronda de evaluación, pues todos los ítems evaluados obtuvieron CVC igual o superior a 0,8 en esta rodada. Los folletos fueron considerados validados ya en la primera rodada de evaluación, pues todos los ítems también obtuvieron CVC superior a 0,8 durante esta rodada. Conclusión: Considerando los resultados obtenidos, el protocolo se presenta como una herramienta importante al guiar la conducta médica en el proceso de desprescripción del clonazepam.

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Purpose: The aim of the present study was to develop and validate a Potentially Inappropriate Medications (PIM) list and alternative therapies for treatment of pain and inflammation in older people adapted to the Brazilian context. Methods: A preliminary PIM list suitable for the Brazilian market was developed on the basis of three published international PIM lists [Beers 2015, Screening Tool of Older People's Potentially Inappropriate Prescriptions - 2015, European Union (7) PIM list]. We used the modified Delphi technique (two-round) to validate concerns of use and alternative therapies related to PIM for treatment of pain and inflammation in older adults ≥65 years in Brazil. The panel involved nine Brazilian experts in geriatric pharmacotherapy. All items with mean Likert scale score ≥4.0 (agree) and the lower limit of 95% confidence interval ≥4.0 were considered validated in this study. Results: At the end of the consensus process, 94 (65.3%) items of 144 were validated. In total, consensus was reached for 33/35 (94.3%) concerns about drugs that should be avoided in older patients regardless of diagnosis, for 22/23 (95.7%) concerns about drugs that should be avoided in older patients with specific conditions or diseases, for 11/23 (47.8%) with special considerations of use, and for 28/63 (44.4%) of therapeutic alternatives. Conclusion: Although these criteria are not designed to replace clinical judgement, PIM and alternative therapies lists can be useful to inform prescribers, pharmacists, and health care planners and may serve as a starting point for safe and effective use of medications in older people.

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PURPOSE: In this article we describe a novel required longitudinal experience focused on deprescribing designed for postgraduate year 2 (PGY2) geriatric pharmacy residents. This experience was embedded within a clinical pharmacist-driven deprescribing service. Insights on challenges faced and benefits gained during the first offering are also highlighted. SUMMARY: Through collaboration with the University of Pittsburgh School of Pharmacy (UPMC) Palliative and Supportive Institute and the UPMC St. Margaret PGY2 geriatric pharmacy residency program, a year-long required deprescribing-focused experience was developed and executed. The experience was aligned with the American Society of Health-System Pharmacists' standard goals and objectives and was designed to focus and evaluate 3 skills necessary for all pharmacy practitioners: empathy, critical thinking, and communication. There is a need for proactive deprescribing initiatives to reduce the unnecessary burden and cost associated with potentially inappropriate medications for older patients. Focused deprescribing experiences can better equip pharmacist learners with the ability to lead these initiatives. CONCLUSION: A required longitudinal deprescribing-focused experience can provide PGY2 geriatric pharmacy residents with opportunities to practice empathy, critical thinking, and communication beyond those typically offered in a residency program.

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RESUMEN Objetivo Realizar la notificación y verificar el seguimiento de cinco alertas sanitarias de medicamentos a un grupo de prestadores de salud en Colombia. Métodos Estudio cuasi-experimental, prospectivo, antes y después, sin grupo control, mediante una intervención en médicos prescriptores de ketoconazol, metoclopramida, nimesulida, diacereina, ranelato de estroncio. Se tomó como población universo a los afiliados al régimen contributivo del Sistema de Salud Colombiano en 13 entidades promotoras de salud (EPS) de Colombia. Se identificaron los pacientes que recibían mensualmente estos medicamentos previamente a la alerta. Se realizó una intervención educativa y posteriormente se midió la proporción de cambio en la dispensación. Resultados Se realizaron en total unas 26 actividades diferentes a 500 médicos prescriptores. De un total de 4 121 954 de personas se identificaron 13 979 pacientes mensuales en 2013 que recibían alguno de los cinco medicamentos y se observó una reducción en 1 470 sujetos al mes (-10,5%) para 2014. El medicamento con el que se consiguió la mayor reducción fue ketoconazol (-31,1% de casos), seguido de ranelato de estroncio (-30,3%) y metoclopramida (-8,6%). Para nimesulida (+0,7%) y diacereina (+16,4%) no se obtuvieron resultados favorables. Conclusiones Se mantienen prescripciones potencialmente riesgosas en pacientes de Colombia. Con intervenciones basadas en farmacovigilancia posterior al reporte de alertas por agencias reguladoras sanitarias, se puede disminuir la proporción de pacientes que utilizan estos medicamentos.(AU)

ABSTRACT Objective Make the notification and monitoring compliance with five health drug alerts to a group of health care providers in Colombia. Methods Quasi-experimental, prospective, before-after study, without control group, by intervening in physician prescribers of ketoconazole, metoclopramide, nimesulide, diacerein, strontium ranelate. The affiliated population of the contributory system of the Colombian Health System was taken as the universe population sample from 13 health promoting entities (EPS) of Colombia. Patients receiving monthly these drugs prior to the alert were identified. An educational intervention was performed and then the rate of change in the dispensation was measured. Results About 26 different activities were conducted on 500 prescribers. Out of a total of 4 121 954 people, 13 979 patients were identified monthly in 2013, who received some of the five medications. Likewise, a reduction in 1,470 subjects per month (-10.5%) for 2014 was observed. The drug which achieved the greatest reduction was ketoconazole (-31.1% of cases), followed by strontium ranelate (-30.3%) and metoclopramide (-8.6%). For nimesulide (+ 0.7%) and diacerein (+ 16.4%) no favorable results were obtained. Conclusions Patients with potentially risky prescriptions remain in Colombia; educational pharmacovigilance interventions made after the report alerts given by drug regulatory agencies may decrease the proportion of patients using these drugs.(AU)

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Potentially Inappropriate Medication for the elderly (PIM) are drugs in which the safety risks may exceed the benefits, especially when there are safer alternatives. The use of PIM is associated with increased hospitalizations and it is estimated that one every five prescriptions presents at least one PIM. In this context, there are several assessment tools for identification of PIM. The first assessment tool developed was Beers criteria and since its publication, new tools have been developed. The objective of this scoping review is to explore studies presenting assessment tools of PIM to map characteristics, justifications, and therapeutic equivalents. This review will consider studies that developed or validated an assessment tool of PIM. Electronic searches will be performed in PubMed and Scopus with no time limit. Two researchers, independently, will select registries and extract data of studies and tool characteristics, PIM and potentially inappropriate interaction, condition, justification, and therapeutic equivalents. The findings will be presented in narrative form including tables and figures to aid in data presentation, where appropriate.(AU)

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