Potentially inappropriate medications in older outpatients with depression: a cross-sectional study comparing the Beers criteria and the Chinese criteria

Objective To determine the prevalence of PIMs and identify associated factors in older Chinese outpatients with depression, using a combined evaluation based on the 2023 Beers criteria and the 2017 Chinese criteria. Methods A cross-sectional study was conducted at a provincial tertiary psychiatric hospital in China, enrolling older outpatients (≥ 65 years) diagnosed with depression. PIM status was identified according to the 2023 Beers criteria and the 2017 Chinese criteria. Logistic regression analyses were performed to identify factors associated with PIMs. Interaction, subgroup, and sensitivity analyses were also performed. Results Among 3,155 eligible patients (mean age 74.22 ± 6.70 years), PIM prevalence was 92.71% under the Beers criteria and 65.13% under the Chinese criteria. Under both criteria, quetiapine, benzodiazepines and sedative-hypnotics were the most frequently identified as PIMs. Female sex (Beers: aOR = 1.57, 95% CI: 1.16-2.12; Chinese: aOR = 1.44, 95% CI: 1.20-1.73), polypharmacy (Beers: aOR = 2.43, 95% CI: 2.08-2.85; Chinese: aOR = 2.51, 95% CI: 2.30-2.74), and comorbid sleep disorders (Beers: aOR = 1.79, 95% CI: 1.27-2.51; Chinese: aOR = 3.67, 95% CI: 2.99-4.50) were associated with high use of PIM under both criteria. In contrast, coronary heart disease and number of comorbidities were negatively associated factors, and ischemic stroke showed criterion-dependent differences in its association with PIMs. Conclusion The prevalence of PIMs among older Chinese outpatients with depression was remarkably high in this cohort, with associations partly different across the two criteria. The single-center retrospective design, unmeasured confounders, unavailability of renal function data, and lack of follow-up assessment warrant cautious interpretation of the results. Multidisciplinary medication review and individualized deprescribing strategies can be implemented in clinical practice for this vulnerable population.