{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T12:10:25Z","timestamp":1789992625217,"version":"4.0.1"},"reference-count":38,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T00:00:00Z","timestamp":1789862400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Potentially inappropriate medication (PIM) use is associated with adverse clinical outcomes in older adults. Several explicit screening tools are available for identifying PIMs, but Romanian data regarding the application of updated criteria remain limited. This study aimed to assess PIM identification according to the STOPP v3, Beers, EU(7)-PIM criteria and PRISCUS v2, to compare PIM counts and PIM presence across criteria, and to explore associations between PIM counts and selected patient characteristics. Materials and Methods: A retrospective observational study with a cross-sectional design was conducted in a single family medicine practice in Iasi, Romania, including 100 patients aged \u2265 65 years with at least one chronic condition and receiving at least two medications. Medications documented between January and June 2024 were assessed using the four explicit PIM criteria. One-way ANOVA with Bonferroni correction, repeated-measures ANOVA, agreement analyses, and Poisson regression models were used to examine differences between criteria and associations with patient characteristics, multimorbidity, and medication burden. Results: Mean PIM counts ranged from 0.75 for PRISCUS to 1.31 for STOPP. At least one PIM was identified in 73% of participants according to STOPP, 62% according to Beers, 60% according to EU(7)-PIM, and 53% according to PRISCUS. STOPP identified significantly more PIMs than each of the other three criteria (p &lt; 0.001), while pairwise kappa coefficients ranged from 0.506 to 0.777. Among the 16 one-way ANOVA comparisons, only the association between obesity and EU(7)-PIM counts remained significant after Bonferroni correction (p &lt; 0.001). In adjusted Poisson models, medication burden was associated with PIM counts according to STOPP (p &lt; 0.001), Beers (p = 0.016), and EU(7)-PIM (p = 0.018). Obesity remained associated with EU(7)-PIM counts (p = 0.001), multimorbidity with STOPP PIM counts (p = 0.049), and sex with PRISCUS PIM counts (p = 0.030). Age, type 2 diabetes mellitus, and dyslipidemia were not independently associated with PIM counts. Conclusions: PIM identification varied according to the explicit criteria applied, with STOPP identifying the highest mean PIM count. Medication burden was the factor most consistently associated with PIM counts in adjusted analyses, while other patient characteristics showed criterion-specific associations. Given the small sample, single-practice setting, and non-probability sampling approach, these findings should be considered exploratory and require confirmation in larger, multicenter primary care studies.<\/jats:p>","DOI":"10.3390\/medicina62091813","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T10:25:43Z","timestamp":1789986343000},"page":"1813","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Potentially Inappropriate Medication Use in Older Adults in Primary Care According to Four Explicit Criteria: Associations with Patient Factors"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-8179-4103","authenticated-orcid":false,"given":"Mihaela","family":"Paraschiv","sequence":"first","affiliation":[{"name":"Discipline of Pharmacodynamics and Clinical Pharmacy, Department of Pharmaceutical Sciences II, Faculty of Pharmacy, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3948-6496","authenticated-orcid":false,"given":"Alexandru","family":"Vasincu","sequence":"additional","affiliation":[{"name":"Discipline of Pharmacodynamics and Clinical Pharmacy, Department of Pharmaceutical Sciences II, Faculty of Pharmacy, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4799-325X","authenticated-orcid":false,"given":"R\u0103zvan-Nicolae","family":"Rusu","sequence":"additional","affiliation":[{"name":"Discipline of Pharmacodynamics and Clinical Pharmacy, Department of Pharmaceutical Sciences II, Faculty of Pharmacy, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Oana Irina","family":"Gavril","sequence":"additional","affiliation":[{"name":"Department of Medical Specialties I, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"resources","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Bogdan Andrei","family":"Trandab\u0103\u021b","sequence":"additional","affiliation":[{"name":"Department of Surgery II, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"resources","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0448-253X","authenticated-orcid":false,"given":"Andrei","family":"Ciob\u00eec\u0103","sequence":"additional","affiliation":[{"name":"Romanian Association of Algesiology, 700117 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"software","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1636-0345","authenticated-orcid":false,"given":"Veronica","family":"Bild","sequence":"additional","affiliation":[{"name":"Discipline of Pharmacodynamics and Clinical Pharmacy, Department of Pharmaceutical Sciences II, Faculty of Pharmacy, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"\u201cOlga Necrasov\u201d Center of Anthropological and Biomedical Research, Romanian Academy, Iasi Branch, 700506 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,20]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2026, March 22). Promoting Rational Use of Medicines. Available online: https:\/\/www.who.int\/activities\/promoting-rational-use-of-medicines."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Hire, A.J., and Franklin, B.D. (2024). Potentially inappropriate prescribing (PIP) in older people and its association with socioeconomic deprivation-a systematic review and narrative synthesis. BMC Geriatr., 24.","DOI":"10.1186\/s12877-024-04858-w"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"16774","DOI":"10.1038\/s41598-022-19860-8","article-title":"Prevalence of potentially inappropriate prescribing in older adults in Central and Eastern Europe: A systematic review and synthesis without meta-analysis","volume":"12","author":"Brkic","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Bare, M., Lleal, M., Ortonobes, S., Gorgas, M.Q., Sevilla-Sanchez, D., Carballo, N., De Jaime, E., Herranz, S., and MoPIM study group (2022). Factors associated to potentially inappropriate prescribing in older patients according to STOPP\/START criteria: MoPIM multicentre cohort study. BMC Geriatr., 22.","DOI":"10.1186\/s12877-021-02715-8"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Lau, S., Lun, P., Ang, W., Tan, K.T., and Ding, Y.Y. (2020). Barriers to effective prescribing in older adults: Applying the theoretical domains framework in the ambulatory setting\u2014A scoping review. BMC Geriatr., 20.","DOI":"10.1186\/s12877-020-01766-7"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1007\/s00228-015-1954-4","article-title":"Potentially inappropriate prescribing in community-dwelling older people across Europe: A systematic literature review","volume":"71","author":"Tommelein","year":"2015","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e2326910","DOI":"10.1001\/jamanetworkopen.2023.26910","article-title":"Prevalence of Use of Potentially Inappropriate Medications Among Older Adults Worldwide: A Systematic Review and Meta-Analysis","volume":"6","author":"Tian","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e491","DOI":"10.3399\/BJGP.2020.1048","article-title":"Prevalence and predictors of potentially inappropriate prescribing in middle-aged adults: A repeated cross-sectional study","volume":"71","author":"Khatter","year":"2021","journal-title":"Br. J. Gen. Pract."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1177\/1060028019853069","article-title":"Associations Between Potentially Inappropriate Medications and Adverse Health Outcomes in the Elderly: A Systematic Review and Meta-analysis","volume":"53","author":"Xing","year":"2019","journal-title":"Ann. Pharmacother."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1007\/s00228-018-2446-0","article-title":"Potentially inappropriate medication in the elderly: A systematic review of validated explicit criteria","volume":"74","author":"Motter","year":"2018","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Diez, R., Cadenas, R., Susperregui, J., Sahagun, A.M., Fernandez, N., Garcia, J.J., Sierra, M., and Lopez, C. (2022). Potentially Inappropriate Medication and Polypharmacy in Nursing Home Residents: A Cross-Sectional Study. J. Clin. Med., 11.","DOI":"10.3390\/jcm11133808"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1007\/s41999-023-00777-y","article-title":"STOPP\/START criteria for potentially inappropriate prescribing in older people: Version 3","volume":"14","author":"Cherubini","year":"2023","journal-title":"Eur. Geriatr. Med."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"(2023). American Geriatrics Society Beers Criteria\u00ae Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria(R) for potentially inappropriate medication use in older adults. J. Am. Geriatr. Soc., 71, 2052\u20132081.","DOI":"10.1111\/jgs.18372"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1007\/s00228-015-1860-9","article-title":"The EU(7)-PIM list: A list of potentially inappropriate medications for older people consented by experts from seven European countries","volume":"71","author":"Meyer","year":"2015","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_15","first-page":"3","article-title":"Potentially Inadequate Medications in the Elderly: PRISCUS 2.0","volume":"120","author":"Mann","year":"2023","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e2417988","DOI":"10.1001\/jamanetworkopen.2024.17988","article-title":"Potentially Inappropriate Medication Use in Primary Care in Switzerland","volume":"7","author":"Schietzel","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Zhao, M., Chen, Z., Xu, T., Fan, P., and Tian, F. (2023). Global prevalence of polypharmacy and potentially inappropriate medication in older patients with dementia: A systematic review and meta-analysis. Front. Pharmacol., 14.","DOI":"10.3389\/fphar.2023.1221069"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"105465","DOI":"10.1016\/j.archger.2024.105465","article-title":"Global and regional prevalence of polypharmacy and related factors, 1997\u20132022: An umbrella review","volume":"124","author":"Kim","year":"2024","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1007\/s40266-023-01024-6","article-title":"The EURO-FORTA (Fit fOR The Aged) List Version 2: Consensus Validation of a Clinical Tool for Improved Pharmacotherapy in Older Adults","volume":"40","author":"Pazan","year":"2023","journal-title":"Drugs Aging"},{"key":"ref_20","unstructured":"OECD, and European Observatory on Health Systems and Policies (2025). State of Health in the EU: Romania Country Health Profile 2025, OECD."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.vhri.2021.05.003","article-title":"A Systematic Review of Potentially Inappropriate Medications Use and Related Costs Among the Elderly","volume":"25","author":"Malakouti","year":"2021","journal-title":"Value Health Reg. Issues"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1111\/j.1365-2125.2009.03531.x","article-title":"Potentially inappropriate prescribing in an Irish elderly population in primary care","volume":"68","author":"Ryan","year":"2009","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Blanco-Reina, E., Garcia-Merino, M.R., Ocana-Riola, R., Aguilar-Cano, L., Valdellos, J., Bellido-Estevez, I., and Ariza-Zafra, G. (2016). Assessing Potentially Inappropriate Prescribing in Community-Dwelling Older Patients Using the Updated Version of STOPP-START Criteria: A Comparison of Profiles and Prevalences with Respect to the Original Version. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0167586"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1007\/s40801-019-00175-6","article-title":"Drug Prescription in Older Swiss Men and Women Followed in Family Medicine","volume":"7","author":"Schnegg","year":"2020","journal-title":"Drugs Real World Outcomes"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Baneu, P., Prelipcean, A., Buda, V.O., Jianu, N., Tudor, A., Andor, M., Merlan, C., Romanescu, M., Suciu, M., and Buda, S. (2024). Under-Prescription of Drugs in the Elderly Population of Western Romania: An Analysis Based on STOPP\/START Version 2 Criteria. J. Clin. Med., 13.","DOI":"10.3390\/jcm13195970"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"407","DOI":"10.2147\/CIA.S233270","article-title":"Potentially Inappropriate Prescriptions in Ambulatory Elderly Patients Living in Rural Areas of Romania Using STOPP\/START (Version 2) Criteria","volume":"15","author":"Buda","year":"2020","journal-title":"Clin. Interv. Aging"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"560","DOI":"10.4236\/pp.2014.56066","article-title":"Patterns of Medication Use among Romanian Nursing Home Residents","volume":"5","author":"Primejdie","year":"2014","journal-title":"Pharmacol. Pharm."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2042098620933741","DOI":"10.1177\/2042098620933741","article-title":"An overview of prevalence, determinants and health outcomes of polypharmacy","volume":"11","author":"Khezrian","year":"2020","journal-title":"Ther. Adv. Drug Saf."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/S2213-8587(22)00033-X","article-title":"Body-mass index and risk of obesity-related complex multimorbidity: An observational multicohort study","volume":"10","author":"Kivimaki","year":"2022","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e020270","DOI":"10.1136\/bmjopen-2017-020270","article-title":"Factors associated with polypharmacy in primary care: A cross-sectional analysis of data from The English Longitudinal Study of Ageing (ELSA)","volume":"8","author":"Slater","year":"2018","journal-title":"BMJ Open"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Samara, E., Nazzal, Z., Naghnaghia, S., and Al-Ramahi, R. (2023). Potentially inappropriate medication uses and associated factors among elderly primary health care clinics attendees: A call to action. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0290625"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Alwhaibi, M., and Balkhi, B. (2023). Gender Differences in Potentially Inappropriate Medication Use among Older Adults. Pharmaceuticals, 16.","DOI":"10.3390\/ph16060869"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1591511","DOI":"10.1155\/2022\/1591511","article-title":"Potentially Inappropriate Medications Use among Older Adults with Comorbid Diabetes and Hypertension in an Ambulatory Care Setting","volume":"2022","author":"Alwhaibi","year":"2022","journal-title":"J. Diabetes Res."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Nowakowska, M., Zghebi, S.S., Ashcroft, D.M., Buchan, I., Chew-Graham, C., Holt, T., Mallen, C., Van Marwijk, H., Peek, N., and Perera-Salazar, R. (2019). The comorbidity burden of type 2 diabetes mellitus: Patterns, clusters and predictions from a large English primary care cohort. BMC Med., 17.","DOI":"10.1186\/s12916-019-1373-y"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1007\/s00228-024-03633-5","article-title":"Comparing AGS Beers 2019, STOPP version 2, and EU(7)-PIM list in Portuguese older adults in primary health care","volume":"80","author":"Rodrigues","year":"2024","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Perpetuo, C., Placido, A.I., Rodrigues, D., Aperta, J., Pineiro-Lamas, M., Figueiras, A., Herdeiro, M.T., and Roque, F. (2021). Prescription of Potentially Inappropriate Medication in Older Inpatients of an Internal Medicine Ward: Concordance and Overlap Among the EU(7)-PIM List and Beers and STOPP Criteria. Front. Pharmacol., 12.","DOI":"10.3389\/fphar.2021.676020"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1002\/pds.3429","article-title":"Prescribing potentially inappropriate medication (PIM) in Germany\u2019s elderly as indicated by the PRISCUS list. An analysis based on regional claims data","volume":"22","author":"Schubert","year":"2013","journal-title":"Pharmacoepidemiol. Drug Saf."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e050344","DOI":"10.1136\/bmjopen-2021-050344","article-title":"Comparison of FORTA, PRISCUS and EU(7)-PIM lists on identifying potentially inappropriate medication and its impact on cognitive function in multimorbid elderly German people in primary care: A multicentre observational study","volume":"11","author":"Kruger","year":"2021","journal-title":"BMJ Open"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/9\/1813\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T11:29:11Z","timestamp":1789990151000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/9\/1813"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,20]]},"references-count":38,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["medicina62091813"],"URL":"https:\/\/doi.org\/10.3390\/medicina62091813","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,20]]}}}