The Screening Tool of Older Person's Potentially Inappropriate Prescriptions (STOPP) and the Screening Tool to Alert to Right Treatment (START) were initially developed by a panel of experts from Cork University Hospital, Ireland in 2008, and underwent a second update in 2015. Since their inception, these criteria have played a pivotal role in identifying potentially inappropriate medication use in the elderly, enhancing oversight of medication misuse in older individuals, and reducing adverse drug events among the elderly. In 2023, the third edition of the STOPP/START criteria was released, providing updated and more practical evidence-based guidance. Building upon the second edition, this iteration includes the addition, revision, and removal of certain criteria, resulting in a total of 190 new standards for potentially inappropriate medication use. This latest version incorporates the most recent research findings and clinical evidence related to appropriate medication use in older adults. We provide a detailed analysis of the STOPP/START criteria (version 3), offering valuable insights for the updating and refinement of potentially inappropriate medication criteria in our country. Furthermore, it presents recommendations for future research in this field.

With the acceleration of population aging, the problem of multi-drug comorbidity among the elderly is serious, and community health service centers have become an important way for the elderly to obtain various health services. However, the management of medication for elderly patients in primary health care institutions is still in a weak state.

To explore the influence of the rational medication management model on patients' knowledge, belief and behavior of medication in the community elderly, and to provide a realistic basis for improving the medication behavior of the elderly.

From September to December 2021, two community health centers in Jinshan District, Shanghai were selected as the sample source, elderly patients with chronic disease comorbidity with contracted general practitioner were studied. The contracted elderly patients from one of the community health service centers were randomly selected as the intervention group (n=223), and the contracted elderly patients from another community health service center were selected as the control group (n=198). Baseline matching between groups was performed using a propensity matching score (PSM) in a 1∶1 ratio. Patients in the control group adopted the conventional chronic disease management plan, patients in the intervention group were medication-integrated and instructed to use the Health Care Handbook of Medication for the Elderly and split pill boxes during medication administration, implementing a rational drug use management mode of the elderly in community. The patients' medication knowledge, belief and behavior scores and standardized medication use behaviors at enrollment and after 3 months of follow-up were recorded, and changes before and after the intervention were analyzed.

After PSM, a total of 141 pairs were successfully matched, and the difference between the basic situation of the intervention group and the control group after matching was not statistically significant (P>0.05). After the intervention, the difference between the patients' knowledge of rational medication, belief, medication adherence score, and the development of standardized medication habits in the intervention group was statistically significant compared with the pre-intervention situation (P<0.05). After the intervention, the patient's knowledge of rational medication use, belief, and medication adherence scoreswere higher than those of the control group in the intervention group. Knowledge of rational medication, belief, and medication adherence scorewere higher than those in the control group, and the difference was statistically significant (P<0.05). After the intervention, the proportion of patients in the intervention group who established the habit of reminding medication, placed medication in a conspicuous location, and involved family members to assist with medication reminders, used split pill boxes, and recorded medication notes were higher than those in the control group. The difference was statistically significant (P<0.05) .

The rational medication management model for the elderly in the community can help strengthen the family doctor team services, enhance the patients' knowledge and belief in rational medication use, and improve the patients' adherence and standardization of medication use behavior.

Polypharmacy is increasingly common in the elderly. The medication compliance of polypharmacy is closely related to its therapeutic effect and safety. Therefore, it is of great significance to understand the medication compliance and its influencing factors in the elderly with polypharmacy at early stage. However, the conclusions of current studies vary greatly, and there is no clear and unified standard.

To systematically evaluate the current status of polypharmacy in the elderly and its influencing factors, in order to provide reference for improving medication compliance of polypharmacy in the elderly, reducing adverse reactions, and further developing individualized intervention programs.

PubMed, Embase, Web of Science, Cochrane Library, Scopus, Ovid, CBM, CNKI, Wanfang Data and VIP were searched for cohort studies, case-control studies, cross-sectional studies and other observational studies on the influencing factors of medication compliance of polypharmacy in the elderly from inception to March 2023. Two researchers independently screened the literature, evaluated the quality and extracted the data according to the inclusion and exclusion criteria. Stata 17.0 and RevMan 5.3 software were used for meta-analysis.

A total of 19 studies were included with the total sample size of 130 047 subjects, including 50 852 subjects with good medication compliance. Meta-analysis results showed that the medication compliance rate of polypharmacy in the elderly was 41%〔95%CI (34%, 47%) 〕, which was associated with age〔OR=2.62, 95%CI (1.60, 4.78), P<0.000 1〕, gender〔OR=1.70, 95%CI (1.30, 2.23), P=0.000 1〕, education level〔OR=1.73, 95%CI (1.38, 2.16), P<0.000 01〕, residential lifestyle〔OR=2.85, 95%CI (2.18, 3.72), P<0.000 01〕, medication knowledge level〔OR=1.14, 95%CI (1.04, 1.25), P=0.005〕, medication belief〔OR=2.06, 95%CI (1.44, 2.93), P<0.000 1〕, depression〔OR=2.52, 95%CI (1.96, 3.24), P<0.000 01〕, daily living ability (ADL) 〔OR=2.39, 95%CI (1.68, 3.38), P<0.000 01〕, history of falls〔OR=3.51, 95%CI (2.03, 6.06), P<0.000 01〕, professional guidance 〔OR=3.75, 95%CI (1.92, 7.33), P=0.000 1〕, the number of drug types〔OR=2.58, 95%CI (1.96, 3.41), P<0.000 1〕, adverse drug reactions〔OR=3.08, 95%CI (2.17, 4.38), P<0.000 1〕, medication regimen complexity〔OR=1.08, 95%CI (1.03, 1.14), P=0.004〕, medication management〔OR=1.92, 95%CI (1.34, 2.75), P=0.000 3〕 and medication cost〔OR=2.60, 95%CI (1.30, 5.17), P=0.000 7〕. Sensitivity analysis showed that the results of meta-analysis were relatively stable. Begg's test (P=0.441) and Egger's test (P=0.674) suggested that there was a low risk of publication bias for medication compliance of polypharmacy in the elderly in the included studies.

The compliance rate of polypharmacy in the elderly is 41%. And the available evidence shows that general factors (age, gender, education level, residential lifestyle), psychological and social factors (depression, ADL, history of falls, medication knowledge level, medication belief, professional guidance), drug factors (medication management, medication cost, medication regimen complexity, the number of drug types, adverse drug reactions) are the influencing factors of medication compliance of polypharmacy in the elderly. Medical staff should formulate individualized intervention measures and optimize disease management in the elderly with polypharmacy according to the influencing factors of medication compliance of polypharmacy.

An increasing number of studies have demonstrated that potentially inappropriate medication (PIM) occurs commonly in elderly patients with cancer, with higher prevalence of PIM than general elderly, which may lead to adverse effects on prognosis of the patients. Therefore, it is necessary to conduct a systematic and comprehensive review of previous studies to provide support and reference for future studies. PubMed, CNKI and Wanfang Data were systematically searched to summarize and analyze the screen tools of PIM, prevalence of PIM, main drugs involved, influencing factors and the relationship between PIM and adverse outcomes. The results showed that the prevalence of PIM varied when different PIM screen tools were used in older patients with cancer, and the list of medications commonly used for supportive care that are of concern in older patients provided by the NCCN Guidelines for Older Adult Oncology (2020.v2) demonstrated advantages in providing individualized medication management for elderly patients with cancer. Polypharmacy, age, and comorbidities were significantly associated with the development of PIM. Benzodiazepines and analgesics are commonly used as high-risk drugs in elderly patients with cancer. PIM may be associated with higher mortality rates, drug interaction rates, adverse event rates, emergency and hospital readmission rates in elderly patients with cancer. It is hoped that this article will provide a reference for conducting studies related to PIM in elderly patients with cancer in China and provide support for promoting the safe and rational use of medication in elderly patients with cancer.

In recent years, there has been a noticeable increase in the prevalence of polypharmacy among the older population, leading to a rise in the number of related studies. As a result, a stage analysis of its development is crucial.

To analyze the research trends and cutting-edge topics in the field of polypharmacy in the elderly from 2003 to 2022.

The Science Citation Index Expanded (SCI-E) and Social Sciences Citation Index (SSCI) subsets of the Web of Science Core Collection database were searched for articles and reviews about polypharmacy in the elderly published in English between 2003 and 2022. VOSviewer (v.1.6.18) and CiteSpace (v.6.1.R6) were used for bibliometric analysis.

A total of 3 987 articles were obtained, including 3 208 articles and 779 reviews. The global volume of publications has increased rapidly in the last 20 years, with the United States (1 097 articles, 27.51%) having the most publications in this field. The University of Sydney in Australia has been the most prolific institution, publishing 156 articles (3.91%), while Dr. Sarah N. Hilmer of this institution has been the most productive author with 67 publications (1.68%). Among the journals, Drugs & Aging (181 articles, 4.54%) has featured the highest number of publications related to polypharmacy in older people. The high-frequency keywords in the field included elderly, polypharmacy, prevalence, and risk, while the current emerging topics revolved around clinical outcomes and public health issues about polypharmacy in the elderly.

Over the past two decades, the field of polypharmacy among older people has experienced rapid progress, characterized by an increasing number of publications with the United States as the largest contributor. Research topics have primarily focused on the prevalence and risks associated with polypharmacy among older people, while future studies are expected to focus more on the associated clinical outcomes and public health issues.

The Beers criteria is a tool for evaluating potentially inappropriate medication (PIM) in elderly patients widely used in various fields, such as clinical practice, teaching research, supervision and administration. The 2023 American Geriatrics Society Beers criteria (AGS Beers criteria) for PIM use in older adults are the seventh overall update, using the development methodology following previous versions, which includes the rigor of the evidence review and synthesis process. This paper provides a detailed interpretation of the new version of AGS Beers criteria. The AGS Beers criteria aims to reduce the incidence of PIM in older adults by optimizing drug selection. The 2023 AGS Beers criteria can also be used in the education of clinicians and patients, assessment of care quality, health care costs and drug use patterns in older adults. In addition to the five tables associated with PIM as main contents, several drugs and criteria have been added based on updated evidence, mainly on the revisions and streamlining of existing drugs and criteria. The added and revised content mainly involves anticoagulants, antiplatelet agents and hypoglycemic agents. The synthesis of anticoagulation recommendations has been added in the new version of AGS Beers criteria. Thirty-three drugs were removed due to low usage or not on the U.S. market. The 2023 AGS Beers criteria summarizes seven principles on the application of Beers criteria to ensure proper clinical use. Overall, the 2023 AGS Beers criteria have improved its accuracy and utility, which can better identify and reduce PIM prescriptions for the elderly patients and further guide the clinical development of rational drug use regimens.

Our research team has previously conducted investigation on platform for evaluation management and consultation services of polypharmacy among older patients needs of healthcare professionals to ensure a close association between the design and development of the platform and actual needs. However, the awareness of the risks associated with polypharmacy in the elderly and needs of manage services and consultations based on Internet among general population have been rarely reported in China.

To understand the awareness of platform for evaluation management and consultation services of polypharmacy among older patients of general population, so as to further explore the operation mode of the platform and provide guidance for its improvement and refinement.

The self-designed Questionnaire on Platform for Evaluation Management and Consultation Services of Polypharmacy among Older Patients Needs of General Population focusing on the operation mode and importance of each function were distributed to the users of HeFen Club platform of China Mobile from 2021-09-29 to 2021-10-09, using HeFen Club WeChat public platform of China Mobile as the investigation platform and web-based questionnaire survey for general population as the investigation method. Principal component analysis was used to extract common factors for each platform function, and Kaiser's normalized maximum variance method was further used to rotate the factors and rank the mean scores of each factor to explain the relative importance of each factor.

A total of 29 502 valid questionnaires were collected in this study with a recovery rate of 94.89%. The cumulative total variance explained by the fourth factor in the sum of squared factor extracted for the 12 platform functions (patient compliance evaluation, prescription appropriateness evaluation, prescription economy evaluation, medication administration notification and reminder, medication administration precautions, medication administration record management, potential medication problem reminder, manual real-time consultation, manual non-real-time consultation, self-service query, medication administration reminder, and record analysis) was 76.791%; The 12 platform functions were finally extracted into 4 factors, named as reminder factor (F1) , evaluation factor (F2) , query and record factor (F3) and consultation factor (F4) , and the ranking of the mean values of the 4 factors in descending order was F2 (mean factor score of 0.507) , F1 (mean factor score of 0.457) , F3 (mean factor score of 0.430) , and F4 (mean factor score of 0.253) .

Nearly 90.00% of the respondents believe that older adults with multiple common diseases are at risk of polypharmacy and need a platform for management and consultation services of polypharmacy. From a public perspective, reminder, evaluation, querying and record, consultation are the main operation modes and core functions of the platform for evaluation management and consultation services of polypharmacy among older patients.

China's aging adults are increasing, and have increasing prevalence of multimorbidity and polypharmacy, leading to a high risk of drug-drug interactions and adverse drug reactions. There are few studies on potentially inappropriate medication (PIM) in the elderly, and PIM in this group has not yet received sufficient attention clinically.

To perform a retrospective analysis of the PIM prevalence and associated factors in elderly outpatients in a hospital using the 2019 Updated AGS Beers Criteria? for Potentially Inappropriate Medication Use in Older Adults (hereinafter referred to as the 2019 Beers Criteria), providing precise medication guidance for clinical rational use of medications in the elderly.

Prescriptions of older outpatients written from January to December 2021 were collected from the "Smart Pharmacy Platform" of Changsha Hospital of Hunan Normal University on January 10, 2022. Each prescription was evaluated independently to find whether there was a PIM using the 2019 Beers Criteria. Multivariate Logistic regression was used to analyze the associated factors of PIM.

The prescriptions of 39 275 outpatients were collected in the analysis, who had an average age of (74.0±6.8) years, an average number of diagnosed illnesses of (1.49±0.81), and an average number of types of drugs used of (2.70±1.75). The overall prevalence of PIM was 31.72% (12 458/39 275), involving 11 134 cases of drug-related PIM, 23 cases of disease- or symptom-related PIM, 2 109 cases of medication should be used with caution-related PIM in elderly patients, 99 cases of drug-drug interactions-related PIM that should be avoided in elderly patients, 2 cases of avoiding drug-related PIM and 8 cases of reducing drug-dose-related PIM in elderly patients with renal insufficiency. The departments with higher incidence of prescribing PIM were neurology〔1 908 (61.17%) 〕, geriatrics〔972 (49.49%) 〕, and general medicine〔1 495 (42.21%) 〕. The major prescribed PIM included benzodiazepines, proton pump inhibitors, oral nonsteroidal anti-inflammatory drugs, and glimepiride. Multivariate Logistic regression analysis showed that age, number of diagnosed illnesses and the number of types of medication were independently risk factors of PIM (P<0.05) .

Advanced age, high number of diagnosed illnesses and high number of types of medication were associated with higher risk of PIM. To promote rational use of drugs, clinicians and pharmaceutists should pay attention to PIM-related risk factors, and do well in screening for potential risks of PIM.

Cognitive dysfunction refers to the functional impairment in one or more cognitive domains, mostly occurs in older adults. Cognitive dysfunction can commonly be divided into subjective cognitive decline (SCD), mild cognitive impairment (MCI) and dementia, depending on the degree of cognitive impairment. People with SCD or MCI have a higher risk of dementia, which seriously affects their quality of life, and imposes a huge burden on families and society. Numerous studies have demonstrated that physical activity is one effective non-pharmacological intervention for cognitive dysfunction, but there are no uniform standards for physical activity programs for cognitive dysfunction worldwide, and China still has no physical activity guidelines based on the values and preferences of older adults with cognitive dysfunction, partially impeding the dissemination and application of relevant evidence. In view of this, we developed a guideline containing eight recommendations that is applicable in China, namely the Clinical Practice Guideline on Non-pharmacological Interventions for Older Adults with Cognitive Dysfunction: Physical Activity, by the use of existing evidence, and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework combined with values and preferences of Chinese older adults with cognitive dysfunction. This guideline will contribute to the reduction of the incidence of cognitive dysfunction, and preventing or slowing the progression of cognitive dysfunction to dementia.

The older adults are high risk population for malnutrition. Malnutrition is closely associated with numerous adverse clinical outcomes, which may seriously affect the physical health and life quality of the older adults, causing heavy burdens on families and society. Therefore, it is of great importance to take effective measures to improve malnutritionin the older adults, and non-pharmacological interventions have been proved to be important measures to improve nutritional status. However, there is no domestic clinical practice guideline for non-pharmacological interventions specifically for malnourished older adults. Therefore, nutrition experts from China Gerontological Nursing Alliance, National Center for Gerontology and National Clinical Research Center for Geriatric Disorders developed the guideline based on the Grading of Recommendation Assessment, Development and Evaluation (GRADE) including 9 recommendations of non-pharmacological intervention formal nourished older adults through a comprehensive search and analysis of the latest domestic and international literature on malnutrition in the elderly, in order to improve malnutrition and quality of life in the older adults. This guideline focuses on malnourished older adults who can be fed orally and enteral nutrition, parenteral nutrition is not covered by the scope of this guideline.

As population aging progresses, the prevalence of multimorbidity and polypharmacy is increasing in older adults, which may increase the risk of potentially inappropriate medication, causing adverse health outcomes.

To systematically assess the prevalence and associated factors of potentially inappropriate medication in community-dwelling Chinese older adults, in order to provide a reference for developing relevant intervention strategies.

In June 2022, we searched databases of CNKI, CQVIP, Wanfang Data, SinoMed, PubMed, EmBase, and Web of Science from inception to June 2022 for studies on potentially inappropriate medication in community-dwelling older adults in China. Two reviewers independently selected studies, extracted data and assessed the quality of included studies according to the Agency for Healthcare Research and Quality methodology checklist. Meta-analysis was conducted using Stata 12.0.

A total of 24 studies were included, including two with high quality and 22 with moderate quality. Meta-analysis showed that the pooled prevalence of potentially inappropriate medication was 34.8%〔95%CI (31.3%, 38.3%) 〕in community-dwelling older adults in China. Pooled estimates showed 75 years or above〔OR (95%CI) =1.261 (1.074, 1.481) 〕, five or more comorbidities〔OR (95%CI) =3.287 (1.405, 7.691) 〕, and taking five or more medications〔OR (95%CI) =1.800 (1.305, 2.481) 〕or taking 10 or more medications〔OR (95%CI) =4.380 (2.612, 7.347) 〕were associated factors of potentially inappropriate medication.

Potentially inappropriate medication is common in community-dwelling older adults in China, whose risk is associated with older age, multimorbidity and polypharmacy. Prevention and management of potentially inappropriate medication should be paid attention to individuals with the above characteristics.

The number of elderly diabetic patients is increasing rapidly with the aggravation of population aging. The coexistence of multiple conditions and polypharmacy are common in elderly diabetic patients. Strengthening clinically rational drug use can effectively reduce the incidence of adverse drug events and improve outcomes in these patients.

To understand the characteristics and patterns of polypharmacy including hypoglycemic, antihypertensive, lipid-lowering, antiplatelet agents in elderly patients with type 2 diabetes, so as to provide a reference for promoting rational medication use.

This study retrospectively selected 240 elderly inpatients with type 2 diabetes who were hospitalized in Department of Endocrinology, the Second Affiliated Hospital of Xi'an Jiaotong University from April 1, 2020 to March 31, 2022 by cluster sampling method in April 2022. The drugs used during hospitalization and post-discharge medication regimens were investigated. Descriptive analysis was used to analyze the treatment regimens of hypoglycemic, antihypertensive, lipid-regulating and antiplatelet.

On average, the participants had (13.93±3.12) diagnoses at discharge, (16.48±5.41) kinds of medications during hospitalization, and (8.21±2.46) kinds of long-term medications after discharge. The rate of polypharmacy after discharge reached 89.2% (214/240). After discharge, 216 cases (90.0%) received hypoglycemic treatment, among whom 44.9% (97/216) used single drug therapy, and 58.3% (126/216) were treated with insulin. One hundred and eighty-three cases (76.2%) were treated with antihypertensive therapy, including 44.3% (81/183) with single drug therapy and 79.2% (145/183) with calcium channel blockers. One hundred and eighty-seven cases (77.9%) received lipid-regulation therapy, and 83.4% (156/187) of them received atorvastatin. One hundred and seventeen cases (48.7%) used antiplatelet drugs, among whom 77.8% (91/117) used aspirin. Eighty-four cases (35.0%) received hypoglycemic, antihypertensive, lipid-regulating and antiplatelet therapies.

Polypharmacy is common in elderly patients with type 2 diabetes, including hypoglycemic, antihypertensive, lipid-regulating, antiplatelet and other therapies, which indicates that they have received pre-treatment relatively comprehensive condition evaluation by medical workers. Although the rate of comprehensive management is high in this group, there are still some potential risks of adverse drug events due to irrational use of some drugs alone or in combination.