Appropriate use of essential medicines in the elderly: a comparison of the WHO essential medicines list and PIM criteria

Purpose The elderly are not only threatened by bad medicines (overtreatment) but also by undertreatment with "good" medicines. Symmetry is required in any patient-centred approach to properly treat older people. The purpose of this study was to perfect the development of an EML and criteria according to the advantages of each and promote the appropriate use of essential medicines in the elderly. Method We compared the EML with four PIM criteria and calculated the proportion of essential medicines included in the criteria. We also summarized the rationale for including medicines in each criterion and analysed higher risk drugs and drug risks. Results Of essential medicines, 26% are included in at least one criterion as PIM. In 11 drug categories of the EML, more than 50% of drugs of each category are included in at least one criterion, and in four categories, all drugs are included. The potentially inappropriate essential medicines (PIEMs) for the elderly focus on cardiovascular drugs and central nervous system drugs. Fifty-nine drugs have been explicitly identified as increasing the risk of falls, increasing mortality and/or having inappropriate long-term use, and the main risk of PIEMs is falls (30.3% of PIEMs). Additionally, 17.9% of essential medicines are labelled as positive drugs in START and/or FORTA (A/B). Conclusion Improving medication information for the elderly in the EML and establishing an essential medicines list for the elderly will promote appropriate drug use in older people worldwide.