Potentially Inappropriate Prescribing Among Older Adults in Slovakia: A Population-Based Study of Pre-Pandemic Trends

Potentially inappropriate medications (PIMs) pose significant risks to older adults. This study analysed trends in PIM prescribing among Slovak older adults before the COVID-19 pandemic. A retrospective population-based study was conducted using data from the National Health Information Centre database from 2015–2018. All outpatients aged ≥65 years receiving ≥1 prescribed medication per year were included. PIMs were identified using the European list of potentially inappropriate medications (EU(7)-PIM list). Consumption was evaluated based on the number of prescribed medicine packages and defined daily doses (DDD/1000 inhabitants/day). Descriptive statistics included frequencies, percentages, and means (±SD). Temporal trends were analysed using linear regression and chi-square tests. The study population increased from 725,730 treated patients in 2015 to 794,104 in 2018, representing 92.6% to 90.8% of the total population aged ≥65 years. A total of 7,923,497 PIM packages were dispensed during the study period. The proportion of PIMs among total medications increased from 19.1% to 20.4%. The top 10 PIMs accounted for 61.6% of all inappropriate medications, with pantoprazole (14.8%), alprazolam (11.7%), moxonidine (6.0%) being the most frequent. Significant temporal trends included increases in apixaban (+123.3%, p=0.003), rivaroxaban (+92.4%, p=0.029), and zolpidem (+42.0%, p=0.008), while verapamil (-23.1%, p=0.001) and diclofenac (-15.0%, p