{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T06:12:50Z","timestamp":1788502370267,"version":"build-2803163510"},"reference-count":31,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"unspecified","delay-in-days":18,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004484","name":"Tehran University of Medical Sciences & Health Services","doi-asserted-by":"crossref","award":["1402-4-221-70729"],"award-info":[{"award-number":["1402-4-221-70729"]}],"id":[{"id":"10.13039\/501100004484","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,8,1]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Potentially inappropriate prescribing (PIP) in the elderly is associated with adverse outcomes and increased healthcare use. We aimed to estimate its prevalence and pattern among the elderly population of Iran using the Screening Tool of Older Persons\u2019 Prescriptions (STOPP) criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective, population-based observational study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Nationwide data of Iran Health Insurance Organization (IHIO) prescription claims from 24 provinces (21 March 2014 to 19 March 2017).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Adults aged \u226560 years with at least one prescription in the dataset were included. The study comprised 2\u2009696\u2009300 older adults who received 28\u2009575\u2009400 prescriptions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Using a two-stage curation process, we selected STOPP version 3 criteria that could be operationalised from dispensing data alone (age, Anatomical Therapeutic Chemical code, dose, duration and concurrent use). For each criterion, we calculated prescription and patient level PIP prevalence overall and among at-risk prescriptions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Across the curated STOPP criteria, 313\u2009315 prescriptions issued to 131\u2009012 patients met at least one PIP criterion. The most frequent PIPs were concurrent beta blocker and diltiazem use (99\u2009027 prescriptions; 1.26% of patients), benzodiazepine therapy \u22654 weeks (89\u2009240 prescriptions; 1.60% of patients), \u22652 anticholinergic drugs (47\u2009079 prescriptions; 0.78% of patients) and concomitant non-steroidal anti-inflammatory drug plus anticoagulant (25\u2009685 prescriptions; 0.38% of patients). PIPs involving acetylcholinesterase inhibitors, ticlopidine, clonidine and methyldopa were rare.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this nationwide claims-based study, about 5% of elderly Iranians were exposed to PIPs, particularly chronic benzodiazepine use, excessive anticholinergic burden and high-risk cardiovascular and antithrombotic combinations. Our findings provide concrete targets for claims-based surveillance and interventions to improve prescribing safety in Iran\u2019s ageing population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-120795","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T12:00:49Z","timestamp":1787227249000},"page":"e120795","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Potentially inappropriate prescribing in Iranian elderly population: a nationwide claims-based analysis"],"prefix":"10.1136","volume":"16","author":[{"given":"Mohammad Amin","family":"Kharaghani","sequence":"first","affiliation":[{"name":"Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reza","family":"Kianipour","sequence":"additional","affiliation":[{"name":"Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6463-4784","authenticated-orcid":false,"given":"Seyed Mohammad-Navid","family":"Ataei","sequence":"additional","affiliation":[{"name":"Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sholeh","family":"Ebrahimpour","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, Alborz University of Medical Sciences, Karaj, Iran (the Islamic Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5457-5999","authenticated-orcid":false,"given":"Zahra","family":"Shahali","sequence":"additional","affiliation":[{"name":"National Center for Health Insurance Research, Tehran, Iran (the Islamic Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5192-0435","authenticated-orcid":false,"given":"Ali","family":"Golestani","sequence":"additional","affiliation":[{"name":"Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0188-9721","authenticated-orcid":false,"given":"Ozra","family":"Tabatabaei-Malazy","sequence":"additional","affiliation":[{"name":"Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"2026090322303017000_16.8.e120795.1","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1038\/s41572-022-00376-4","article-title":"Multimorbidity","volume":"8","author":"Skou","year":"2022","journal-title":"Nat Rev Dis Primers"},{"key":"2026090322303017000_16.8.e120795.2","doi-asserted-by":"crossref","DOI":"10.1186\/s12877-017-0621-2","article-title":"What is polypharmacy? 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