# A Scoping Review on the Prevalence of Potentially Inappropriate Medication and Polypharmacy among Older People in a Lower-middle Income Country

## TL;DR

This study reviews how common inappropriate medications and polypharmacy are among older adults in Nepal, finding high prevalence rates.

## Contribution

The study provides the first scoping review on PIMs and polypharmacy in older people in a lower-middle-income country like Nepal.

## Key findings

- The overall prevalence of PIMs was 28.5% and polypharmacy was 39.48% among older adults in Nepal.
- Benzodiazepines and non-steroidal anti-inflammatory drugs were the most common PIMs identified.
- Studies were mainly from central Nepal, with fewer from eastern and western regions.

## Abstract

There has been an increase in the number of older populations globally leading to a higher likelihood of multi-morbidities necessitating the use of multiple medications. This often poses the risk of potentially inappropriate medications (PIMs) and polypharmacy among older adults, but their data in the Nepalese context are lacking. This scoping review aimed to examine the published literature regarding the use of PIMs and polypharmacy in older people in Nepal. A literature search was conducted using three databases: PubMed, Embase, and Google Scholar. Articles published in English from 2011 to 2024 were retrieved for analysis to identify studies from Nepal, including the prevalence of PIMs and polypharmacy in older people aged ≥60 years. Studies were screened using Covidence (a web-based platform to perform reviews) and data were extracted using a specially designed form. The average values of the prevalence of PIMs and polypharmacy were derived from the selected studies. Seven articles involving 2341 older adults were included. The overall prevalence rates of PIMs and polypharmacy were 28.5% and 39.48%, respectively. Regional representation from Nepal included four studies from central Nepal and one each from western and eastern Nepal. The most common PIMs were benzodiazepines and non-steroidal anti-inflammatory drugs. PIM usage and polypharmacy are widely prevalent in Nepal. Hence, it is imperative to undertake effective measures to promote rational prescription practices for the geriatric population in Nepal.