Contents lists available at ScienceDirect Archives of Gerontology and Geriatrics journal homepage: www.elsevier.com/locate/archger Full Length Article Prevalence and predictors of potentially inappropriate prescribing of central nervous system and psychotropic drugs among elderly patients: A national population study in Korea Hyeonseok Cho a , Junjeong Choi a , Young-Sang Kim b , Sang Joon Son c , Kang Soo Lee d , Hee-Jin Hwang e , Hye-Young Kang a, ⁎ a College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Republic of Korea b Department of Family Medicine, CHA Bundang Medical Center, CHA University, Republic of Korea c Department of Psychiatry, School of Medicine, Ajou University, Republic of Korea d Department of Psychiatry, CHA Bundang Medical Center, CHA University, Republic of Korea e Department of Family Medicine and Institute for Translational & Clinical Research, Catholic Kwandong University International St. Mary's Hospital, Incheon, Republic of Korea ARTICLE INFO Keywords: Aging Central nervous system agents Polypharmacy Potentially inappropriate medication list Psychotropic drugs ABSTRACT Objectives: To investigate the prevalence of potentially inappropriate prescribing (PIP) of central nervous system and psychotropic (CNS-PS) drugs to the Korean elderly population, and to identify PIP-associated factors. Methods: Ambulatory care visits were identified from the 2013 National Aged Patient Sample (HIRA-APS-2013) data, composed of 20% random samples of all enrollees in the universal health security program aged ≥65 years. The CNS-PS section of Screening Tool of Older Person’s potentially inappropriate Prescriptions (STOPP) criteria version 2 was used to identify PIP at these visits. Results: A total of 24,427,069 prescription claims records and 1,122,080 patients were included in the study; 10.73% of the claims and 53.64% of the patients satisfied at least one STOPP criterion in the prescription of CNS- PS drugs. The highest prevalence of PIP was observed for the criteria of “first-generation antihistamines” (FGAH), followed by tricyclic antidepressants (TCA) in patients with prostatism and TCA in patients with de- mentia. The generalized estimating equation logistic regression analysis showed that the PIP of FGAH was significantly associated with polypharmacy (5–9 drugs: odds ratio (OR) 4.965, 95% confidence interval (CI) 4.936–4.994; ≥10 drugs: OR 5.704, 95% CI 5.604–5.807), less severe health conditions (Charlson Comorbidity Index (CCI) = 2: OR 0.852, 95% CI 0.842–0.862; CCI = 1: OR 0.975, 95% CI 0.964–0.986), prescriptions from clinics (OR > 1.0), and outpatient care by general practitioners (OR > 1.0). Conclusions: Appropriate interventions to reduce PIP should be made, especially for the criteria that indicate a high PIP prevalence. Targeted strategies are necessary to modify the risk factors of PIP identified from this study. 1. Introduction The majority of the elderly adult population has one or more chronic conditions that require lifetime treatment. Since pharmaceu- tical intervention is the major treatment strategy for chronic conditions, the safe and optimal use of drugs is important to achieve treatment effectiveness. In general, elderly people receive multiple drug therapy, rendering them vulnerable to drug–drug interaction and duplication of prescriptions (Cahir et al., 2010; Moriarty, Bennett, Fahey, Kenny, & Cahir, 2015; Moriarty, Hardy, Bennett, Smith, & Fahey, 2015). In addition, due to the aging process, the pharmacokinetics and pharmacodynamics become unstable in elderly patients. This makes it difficult to accurately predict the response to drug therapy and the possibility of adverse reactions among elderly patients. Therefore, pharmacotherapy in elderly patients requires appropriate drug and dose selection. To improve the safety and the appropriateness of prescription drug use among senior citizens, efforts have been made to develop explicit criteria for guiding avoidable and recommended drug use. For example, Beers criteria were the first to detect potentially inappropriate pre- scribing (PIP) to elderly patients and is widely used (Bradley et al., 2012). To overcome the shortcomings of Beers criteria—which include http://dx.doi.org/10.1016/j.archger.2017.08.013 Received 16 September 2016; Received in revised form 30 August 2017; Accepted 30 August 2017 ⁎ Corresponding author at: College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, 85 Songdogwahak-ro, Yeonsu-gu, Incheon 21983, Republic of Korea. E-mail addresses: hykang2@yonsei.ac.kr, hykang0712@gmail.com (H.-Y. Kang). Archives of Gerontology and Geriatrics 74 (2018) 1–8 Available online 06 September 2017 0167-4943/ © 2017 Published by Elsevier Ireland Ltd. MARK