Medication appropriateness and potentially inappropriate medications in older critical care patients: a scoping review

Background

Demand for care of older people in critical care units is increasing. During critical care, new medications are initiated. Assessment of potentially inappropriate medication is not routine within this setting, and the clinical utility of medication appropriateness tools, related interventions and their impact on outcomes in the older critical care population has not yet been reviewed.

Objectives

To understand the extent and type of evidence in the assessment of medication appropriateness, intervention strategies and relationship between potentially inappropriate medication use and clinical outcomes in older people in critical care.

Methods

The Preferred Reporting of Items for Systematic Reviews and Meta-Analyses extension for scoping reviews was followed. Embase, MEDLINE, CINAHL, APA PsycINFO and Web of Science were systematically searched (April 2025) for studies assessing medication use in critically ill older people (≥ 60 years). Eligible study designs included randomised and non-randomised trials, cohort studies, cross-sectional studies and case-control studies.

Results

Ten studies (nine patient cohorts) were included. Most were cohort studies originating from North and South America. Benzodiazepines, opioids and antithrombotics were the most common potentially inappropriate medications reported, identified mostly by Beers Criteria and STOPP Criteria. Critical care length of stay was the most frequently associated clinical outcome. No intervention studies were identified.

Conclusions

Medication appropriateness assessment tools have been used to a limited degree to assess medications in older critical care people. Further research is needed to establish their validity, clinical utility and impact on prescribing decisions and to evaluate interventions aimed at improving medication appropriateness and outcomes for older people in critical care.