Prevalence of Potentially Inappropriate Prescribing in Older Adults in Gulf Cooperation Council Countries: A Systematic Review and Meta-Analysis

Introduction: Potentially Inappropriate Prescribing (PIP) poses a significant risk to patient safety and associated with poor healthcare outcomes in Gulf Cooperation Council (GCC) countries. This study aimed to assess PIP prevalence and patterns in older adults across all care settings in GCC.

Methods: A comprehensive search was conducted on six medical databases to identify studies assessing the PIP prevalence in older adults using validated criteria in GCC. Pooled prevalence estimates and odds ratios were calculated using STATA Software (version 16). Statistical heterogeneity was evaluated with the I² statistic, and publication bias was assessed using funnel plot symmetry and Egger's regression test. The risk of bias was assessed using the JBI Prevalence Critical Appraisal Tool.

Results: Fourteen eligible studies conducted over ten years included 18,647 patients. The median prevalence of PIP was 54.4% (IQR: 37.6-62.1%), higher in hospital settings (59.5%; IQR: 53.7-65.3%) compared to primary care (44.2%; IQR: 18.5-54.4%). Cardiovascular medications were the most common PIP (15,353 occurrences). Polypharmacy was significantly associated with PIP exposure (OR: 5.26; 95% CI: 2.33-11.84). The odds of PIP exposure were significantly increased among older individuals with chronic kidney disease (OR: 1.87; 95% CI: 1.19-2.54) and diabetes (OR: 1.74; 95% CI: 1.18-2.30).

Conclusion: This study highlights high PIP prevalence among older adults in GCC countries, particularly in hospital settings. Polypharmacy and certain chronic conditions were significantly associated with PIP exposure. These findings emphasize the need for targeted interventions to improve prescribing practices and medication safety.