. 2021 Jul 16;12:20420986211030371. doi: 10.1177/20420986211030371

Table 2.

Results of included studies (N = 55).

Author	Criteria used	Type of medications	Outcome measured	Adjustments	Statistical unit	Result (95% CI)	p value
Falls
Ackroyd-Stolarz et al.¹³	Beers	Benzodiazepine	Fall	Unadjusted	Prevalence	4.5% (PIM use)3.8% (no PIM use)	0.30
			Fall-related injuries			2.6% (PIM use)1.8% (no PIM use)	0.08
Agashivala and Wu¹⁴	Beers	PIPM	Falls in past 30 days	Unadjusted	OR	1.349 (1.333–1.366)	<0.01
					OR of other Psychoactive medications with PIPM as reference	0.83 (0.702–0.980)	0.028
					OR of non-psychoactive medications with PIPM as reference	0.624 (0.517–0.754)	<0.01
Beer et al.¹⁵	Beers McLeod	PIM use	Falls history	Unadjusted	OR	1.66 (1.42–1.94)	<0.001
		Potential under utilisation		Unadjusted	OR	1.24 (1.06–1.45)	0.008
		Any marker for suboptimal medication use		Unadjusted	OR	1.63 (1.29–2.04)	<0.001
		PIM use		Adjusted	OR	1.23 (1.04–1.45)	0.018
		Potential under utilisation		Adjusted	OR	1.10 (0.93–1.31)	0.278
		Any marker for suboptimal medication use		Adjusted	OR	1.17 (0.91–1.49)	0.227
Berdot et al.¹⁶	Beers	PIM occasional user	Falls	Unadjusted	OR	1.48 (1.26–1.74)	<0.001
			Falls	Adjusted	OR	1.23 (1.04–1.5)	0.016
		PIM regular user	Falls	Unadjusted	OR	1.45 (1.26–1.66)	<0.001
			Falls	Adjusted	OR	1.08 (0.94–1.25)	0.29
Borenstein et al.¹⁷	McLeod Beers	PIM	Falls	Unadjusted	OR	2.93 (1.17–7.34)	<0.05
			Falls	Adjusted	OR	3.05 (1.19–7.83)	<0.05
Cameron et al.¹⁸	Beers	PIM	Falls	Adjusted – any PIM	Beta	0.34 (0.037–0.65)	0.028
		PIM	Falls	Adjusted – benzodiazepine	Beta	NG – reduced falls	0.009
		PIM	Falls	Adjusted – Selective serotonin reuptake inhibitor/serotonin noradrenaline reuptake inhibitor use	Beta	NG – increased falls	0.007
Cardwell et al.⁶³	Drug burden index	PIM	Falls	Adjusted	Relative risk	Maori:
						12 months: 1.49 (0.76–2.92)	0.25
						24 months: 1.32 (0.68–2.57)	0.41
						36 months: 1.08 (0.53–2.19)	0.83
						Non-Maori:
						12 months: 1.09 (0.76–1.56)	0.65
						24 months:1.06 (0.75–1.51)	0.73
						36 months: 1.13 (0.80–1.62)	0.49
Carter et al.¹⁹	Beers	PIM	Fall related ED visit	Not adjusted	Observed counts	3442 falls comprising 47.8% of ED visits. 735 (11.7%) of ED visits had at least 1 PIM	NG
Chun et al.²⁰	Beers	PIM	Falls	NG	Nagelkerke R2	0.017	0.079
Early et al.²¹	Beers, STOPP	Fall-risk drugs, PIM	Falls	Adjusted	OR	Single PIM: 1.021 (0.998–1.044)	>0.05
						Two classes of PIM: 1.128 (1.102–1.154)	<0.05
						Five or more classes of PIM: 1.579 (1.540–1.619)	<0.05
Fernández et al.²²	Beers	PIM	Recurring falls	Adjusted	OR	2.43 (1.08–5.84)	0.028
Frankenthal et al.⁴⁹	STOPP/START	PIM and PPO	Average number of falls	NG	Difference	−0.5 (−0.9245 to −0.0755)	0.006
			Physical component score	NG	Difference	1.1 (−0.59 to 2.80)	0.07
García-Gollarte et al.⁵⁰	STOPP/START	PIM and PPO	Falls	NG	Mean Difference	−0.08	0.251
Hamilton et al.²³	STOPP Beers	PIM	Benzodiazepines users (STOPP) + Falls		Proportion (%)	100
			Benzodiazepines users (Beers) + Falls			91.7
			Opiate users (STOPP) + Falls			100
			Opiate users (Beers) + Falls			0
			Sedative-Hypnotics users (STOPP) + Falls			0
			Sedative-Hypnotics users (Beers) + Falls			0
			Neuroleptics-users (STOPP) + Fall			100
			Neuroleptics-users (Beers) + Falls			20
Hill-Taylor et al.⁵¹	STOPP	Benzodiazepine and zoplicone	Proportion of fallers taking these PIMs		Proportion	21.60%
Ie et al.²⁴	Fall risk-increasing drugs	PIM	Fall-months	Adjusted	Rate ratio	⩾2: 1.67 (1.04–2.68)	<0.05
	Beers	PIM				⩾1: 1.15 (0.72–1.84)	>0.05
	Anticholinergic Cognitive Burden	PIM				>0.655 score: (1.24 (0.80–1.92)	>0.05
	Drug Burden Index	PIM				>0.15 score: 1.51 (0.88–2.58)	>0.05
Manias et al.⁵²	STOPP/START	PIM	Falls	Adjusted	Exp(B) incident count	1.071 (0.883–1.299)	0.484
		PPO	Falls	Adjusted		1.096 (1.000–1.202)	0.051
McMahon et al.²⁵	STOPP	PIM	% prescribing in fallers (pre-fall)	NG	Prevalence	42.2%	0.70
	Beers	PIM	% prescribing in fallers (pre-fall)		Prevalence	44.0%	0.10
Nagai et al.⁵³	STOPP-J	PIM	Subsequent falls in patients with distal radius fractures	Adjusted	OR	1.713 (1.246–2.357)	<0.001
Narayan and Nishtala²⁶	Beers	PIM	Fall-related hospitalisation	Adjusted	IRR	1.45 (1.37–1.52)	<0.05
Ota et al.²⁷	Beers	PIM	Fall, or fracture or injury	Adjusted	OR	0.77 (0.51–1.13)	>0.05
Renom-Guiteras et al.⁶²	EU(7) - PIM List	PIM	Falls	Adjusted	OR	1.54 (1.04–2.30)	<0.05
Schiek et al.²⁸	PRISCUS	PIM	FRIARs (fall-risk-increasing adverse reactions)	Unadjusted	OR	1.966 (1.164–3.320)	<0.05
	EU(7)-PIM	PIM				1.668 (0.900–3.091)	>0.05
	Beers	PIM				1.345 (1.065–1.698)	<0.05
Stockl et al.²⁹	Beers	PIM	Fall or Fracture	Adjusted	HR	1.22 (1.10–1.35)	<0.001
Walker et al.³⁰	Beers	PIM	Risk of falling	Adjusted	OR	1.14 (1.00–1.29)	0.0492
Weeks et al.⁵⁵	STOPP/START	PIM and PPO	Fall and physical restraints	NG	NG	No difference between exposure and controls	>0.05
Falls and Fractures
Dalleur et al.⁵⁶	STOPP/START	PIM	Fall	Adjusted	OR	5.2 (2.2–12.3)	<0.001
		PPO	Osteoporotic fractures	Adjusted	OR	5.0 (2.2–11.4)	<0.001
		PIM	PIM related fall admission in patients with fall-risk-PIM	NG	PPV	0.68
		PPO	PPO related fall admission in patients with fall-risk-PPO		PPV	0.25
Delgado et al.⁵⁷	STOPP	PIM	Fall	Adjusted	HR	1.37 (1.15–1.63)	<0.01
		PIM	Fracture	Adjusted	HR	0.92 (0.70–1.19)	0.51
Fick et al.³¹	Beers	PIM	Fall	Adjusted	OR	4.00 (1.76–9.76)	<0.0001
	Beers	PIM	Fracture	Adjusted	OR	1.14 (0.50–2.65)	0.72
Fick et al.³²	Beers	PIM	Fall	Adjusted	OR	4.05 (1.89–8.69)	<0.01
	Beers	PIM	Hip fracture	Adjusted	OR	3.10 (1.71–5.62)	<0.01
	Beers	PIM	Femur fracture	Adjusted	OR	6.80 (1.95–23.67)	<0.01
Fractures
Hyttinen et al.⁶⁰	Meds75+ Database	PIM	Hip fracture rates	Unadjusted but time-varying model	HR	1.15 (0.94–1.40)	>0.05
				Unadjusted but time-varying model for the incident PIM use period	HR	1.26 (1.02–1.56)	<0.05
				Adjusted time varying model	HR	1.21 (1.00–1.48)	0.056
				Adjusted time varying model for the incident PIM use period	HR	1.31 (1.06–1.63)	0.014
Hyttinen et al.⁶¹	Meds75+ Database	PIM	Fracture related hospitalisations (1 month after exposure)	Adjusted	HR	1.61 (1.11–2.33)	0.013
			Fracture related hospitalisations (3 months after exposure)	Adjusted	HR	1.50 (1.22–1.84)	<0.01
			Fracture related hospitalisations (6 months after exposure)	Adjusted	HR	1.38 (1.21–1.57)	<0.01
Lu et al.³³	Beers	PIM	Fracture related hospitalisations	Adjusted	OR	1.55 (1.48–1.62)	<0.001
ADL
Bonfiglio et al.⁵⁸	STOPP-J	PIM	Bartel Index	Not adjusted	Independent t-test	With PIM: mean = 97.8 (SD = 5.5)	0.541
						Without PIM: mean = 98.7 (SD = 3.1)
De Vincentis et al.³⁴	Beers	PIM	Barthel Index at 3-month follow up	Adjusted	HR	−2 (−7.03 to 3.31)	0.454
	STOPP	PIM	Barthel Index at 3-month follow up	Adjusted	HR	−1 (−6.59 to 4.92)	0.734
	Anticholinergic Cognitive Burden	PIM	Barthel Index at 3-month follow up	Adjusted	HR	−7.55 (−12.37 to −2.47)	0.004
Gosch et al.⁵⁹	STOPP/START	PIM and PPO	ADLs	NG	NG	Low Functional Status	<0.001
Manias et al.⁵²	STOPP/START	PIM	Independence in personal activities of daily living	Adjusted	OR	1.07 (0.95–1.19)	0.261
			Independence in domestic ADL	Adjusted	OR	1.17 (1.01–1.34)	0.036
			Independence in community ADL	Adjusted	OR	1.25 (1.06–1.48)	0.010
Mohamed et al.³⁵	Beers	PIM	Katz ADLs	Adjusted	OR	1.42 (0.87–2.32)	>0.05
Moriarty et al.³⁶	STOPP	PIM	ADL	Adjusted	OR	⩾2 PIM 1.22 (0.74– 2.01)	0.439
	Beers	PIM				⩾2 PIM 2.11 (1.36–3.28)	0.001
	ACOVE PIMs	PIM				⩾2 PIM 1.10 (0.54–2.24)	0.792
	START	PPO				⩾2 PPO 1.98 (1.20–3.26)	0.008
	ACOVE PPOs	PPO				⩾2 PPO 1.82 (1.16–2.86)	0.009
Nagai et al.⁵⁴	STOPP-J	PIM	Bartel Index gain	Adjusted	Beta	−0.313 (−13.188 to −4.430)	<0.001
Pasina et al.⁶⁵	Anticholinergic Cognitive Burden	With anticholinergic medications	Barthel Index ADL	Adjusted	ANOVA	83.5 (81.9–85.0)	0.03
		No anticholinergic medications				86.3 (84.4–88.1)
Renom-Guiteras et al.⁶²	EU(7) - PIM List	PIM	Katz-index of 0–2 versus 6	Adjusted	OR	2.93 (1.85–4.65)	<0.001
			Katz-index of 3–5 versus 6	Adjusted	OR	1.848 (1.19–2.86)	0.006
Tosato et al.³⁷	STOPP Beers	STOPP (PIM versus no PIM)	Decline in physical ADL	Adjusted	OR	2.00 (1.10–3.64)	<0.05
		Beers (PIM versus no PIM)	Decline in physical ADL	Adjusted	OR	1.57 (0.85–2.89)	>0.05
		STOPP (⩾2 PIMs)	Decline in physical ADL	Adjusted	OR	3.50 (1.77–6.91)	<0.05
		Beers (⩾2 PIMs)	Decline in physical ADL	Adjusted	OR	1.90 (0.95–3.81)	>0.05
IADL
Bonfiglio et al.⁵⁸	STOPP-J	PIM	IADL	Not adjusted	Independent t-test	With PIM: mean = 0.8 (SD = 0.1)	0.203
						Without PIM: mean = 0.9 (SD = 0.1)
Cardwell et al.⁶³	Drug burden index	PIM	Functional status, change in Nottingham Extended ADL	Adjusted	Difference in mean score	Māori:
						12 months: 0.49 (0.82–1.11)	0.77
						24 months: 0.55 (−1.36 to 0.81)	0.62
						36 months: 1.01 (−1.99 to 1.98)	1.00
						Non-Māori:
						12 months: 0.36 (−1.22 to 0.20)	0.16
						24 months: 0.41 (−1.20 to 0.39)	0.31
						36 months: 0.49 (−1.01 to 0.89)	0.90
Koyama et al.³⁸	Beers	PIM	IADL impairments	Adjusted	OR	1.36 (1.05–1.75)	<0.05
Mohamed et al.³⁵	Beers	PIM	IADL impairment	Adjusted	OR	1.72 (1.09–2.73)	<0.05
Physical performance
Anson et al.⁶⁶	Quantitative drug index	Falls-risk medications	Berg Balance Scale	Adjusted	Multiple regression	Standardised beta: −0.26	0.02
			TUG Test	Adjusted	Multiple regression	Standardised beta: 0.32	0.007
			TUG Test with cognitive dual task	Adjusted	Multiple regression	Standardised beta: 0.27	0.02
			Activities-specific Balance Confidence	Adjusted	Multiple regression	Standardised beta: −0.32	0.009
Gosch et al.⁵⁹	STOPP/START	PIM and PPO	TUG Test	Adjusted	NG	Low mobility patients have more STOPP items	0.036
				Unadjusted	NG	Low mobility patients have more STOPP items	0.006
Gnjidic et al.⁶⁴	Drug burden index	Anticholinergic and sedative medications	Chair Stand Test (CST)	NG	Difference in time	CST: 0.58 (−0.11 to 1.27)	>0.05
			6 m Walking Speed (6WS)		Difference in speed	6WS: −0.03 (−0.05 to 0.00)	<0.05
			20 cm NWS		Difference in speed	NWS: −0.03 (−0.05 to −0.01)	<0.05
			Grip Strength (GS)		Difference in kg (GS)	GS: −1.09 (−1.90 to −0.28)	<0.01
			Balance		Difference in performance score (Balance)	Balance: −0.11 (−0.18 to −0.03)	<0.01
			IADL		Difference in IADL Score	IADL: 0.18 (0.04–0.32)	<0.01
Kersten et al.⁸	NORGEP Beers	PIM	TUG Test	Adjusted	ANOVA F	0.20	0.80
			HGS (Left Hand)		ANOVA F	2.20	0.10
			HGS (Right Hand)		ANOVA F	1.10	0.30
Naples et al.³⁹	Beers	PIM	GSD	Unadjusted	OR	1.06 (0.92–1.24)	>0.05
			GSD	Adjusted (with time- varying age)	OR	1.08 (0.93–1.26)	>0.05
			GSD	Adjusted (without time-varying age)	OR	1.06 (0.90–1.24)	>0.05
			GSD (slow walkers)	Unadjusted	OR	1.28 (1.03–1.58)	<0.05
			GSD (slow walkers)	Adjusted (with time- varying age)	OR	1.27 (1.02–1.57)	<0.05
			GSD (slow walkers)	Adjusted (without time-varying age)	OR	1.23 (0.97–1.55)	>0.05
			GSD (fast walkers)	Unadjusted		1.15 (0.92–1.44)	>0.05
			GSD (fast walkers)	Adjusted (with time- varying age)		1.13 (0.90–1.42)	>0.05
			GSD (fast walkers)	Adjusted (without time-varying age)		1.03 (0.81–1.31)	>0.05
Sengul Aycicek et al.⁴⁰	Beers	PIM	BPBS – balance	Adjusted	OR	11.05 (2.39–51.10)	0.002
Functional independence score
Bonfiglio et al.⁵⁸	STOPP-J	PIM	Quality of Life VAS	Adjusted	OR	0.973 (0.939–1.008)	0.131
	STOPP-J	PIM	Fried Criteria for Frailty	Adjusted	OR	1.171 (0.676–2.028)	0.573
Chan et al.⁴¹	Beers	PIM	SOF Score	NG	Correlation between change in # of PIMs and change in SOF score from admission to discharge	r = −0.44	<0.001
Chin et al.⁴²	Beers	PIM	Health Related Quality of Life	NG	Score change if prescribed prior to admission	−3.5 (−6.9 to −0.1)	<0.05
					Score change if prescribed in the emergency department	−10.7 (−17.1 to −4.4)	<0.05
					Score change if prescribed upon discharge from emergency department	−12.7 (−20.5 to −4.8)	<0.05
Hasan et al.⁴³	Beers	PIM	Groningen Frailty Indicator	NG	Spearman’s correlation r	0.025 (outpatient)	0.745 (outpatient)
						0.097 (inpatient)	0.206 (inpatient)
	STOPP	Potential inappropriate prescribing				0.041 (outpatient)	0.595 (outpatient)
						−0.065 (inpatient)	0.399 (inpatient)
	Drug burden index	Sedatives and anticholinergics				−0.096 (outpatient)	0.210 (outpatient)
						−0.158 (inpatient)	0.038 (inpatient)
	Beers	PIM	Older People’s Quality of Life	NG	Spearman’s correlation r	−0.157 (outpatient)	0.040 (outpatient)
						−0.085 (inpatient)	0.267 (inpatient)
	STOPP	Potential inappropriate prescribing				−0.052 (outpatient)	0.501 (outpatient)
						0.022 (inpatient)	0.774 (inpatient)
	Drug burden index	Sedatives and anticholinergics				−0.069 (outpatient)	0.369 (outpatient)
						0.034 (inpatient)	0.656 (inpatient)
Iaboni et al.⁴⁴	Beers	PIM	Time to full functional recovery following hip fracture	Adjusted	HR	0.69 (0.52–0.92)	0.012
Kose et al.⁴⁵	Beers	PIM	FIM	Adjusted	FIM gain	−1.393 × change in number of PIM + 5.7	<0.0001
Kose et al.⁴⁶	Beers	PIM	FIM–motor	Adjusted	Linear regression, changes in number of PIMs	Beta = −0.988 (−1.919 to −0.056)	0.0377
Mohamed et al.³⁵	Beers	PIM	OARS PH survey	Adjusted	OR	1.97 (1.15–3.37)	<0.05
Shibasaki et al.⁴⁷	Beers	PIM	FIM gain: FIM at discharge –	Adjusted	Standardised β	0.084	0.260
	START	PPO	FIM at admission			0.180	0.016
Umit et al.⁴⁸	Beers START/STOPP	Prolonged use of benzodiazepines	ECOG Performance status (men)	NG	OR	2.46 (1.91–3.27)	0.007

ACOVE, assessing care of vulnerable elders indicators; ADL, activities of daily living; BPBS, Biosway Portable Balance System; ECOG, Eastern Cooperative Oncology Group; FIM, functional independence measure; GSD, gait speed decline; HGS, hand grip strength; HR, hazard ratio; IADL, instrumental activities of daily living; IRR, incidence rate ratio; NG, not given; NORGEP, Norwegian General Practice; NWS, narrow walking speed; OARS PH, Older Americans Resources and Services Physical Health; OR, odds ratio; PIM, potentially inappropriate medications; PIPM, potential inappropriate psychoactive medications; PPO, potential prescribing omissions; PPV, positive predictive value; SOF, scale of functioning; START, screening tool to alert to right treatment; STOPP, screening tool of older people’s prescriptions; TUG, timed up and go test.