Lau_2025_J.Am.Med.Dir.Assoc__106006

OBJECTIVES: Older people, especially those living with dementia, are susceptible to drug-related problems. This study aimed to calculate the national prevalence and identify factors associated with high-risk prescribing in older people with and without dementia living in Australia. DESIGN: A nationwide cross-sectional study. SETTING AND PARTICIPANTS: Older Australians (<=65 years) using linked 2021 Census and Pharmaceutical Benefits Scheme data. METHODS: Medication use was defined as dispensing during the 3-month period following the Census (August-October 2021). High-risk prescribing included use of potentially inappropriate medications (2023 Beers Criteria and 2024 Australian potentially inappropriate medications [PIMs] list), polypharmacy (<=5 medications), and anticholinergics and sedatives (medications contributing to the Drug Burden Index and the Anticholinergic Cognitive Burden scale). Dementia was defined by self-report in Census or Pharmaceutical Benefits Scheme-dispensed cholinesterase inhibitor/memantine. Sociodemographic factors associated with high-risk prescribing were explored with logistic regression models. RESULTS: Among 3,850,281 individuals, 177,809 (4.6%) had dementia. People with dementia had a higher prevalence of high-risk prescribing (82.7%) compared with those without dementia (65.4%). Among individuals with dementia, the difference in high-risk prescribing prevalence compared with those without dementia was greatest in the younger age groups and progressively narrowed in the oldest age groups. Residing in nonprivate dwellings, requiring assistance with core activities, and having more comorbidities increased the likelihood of high-risk prescribing. Higher education, socioeconomic status, and culturally and linguistically diverse backgrounds were linked to lower likelihood. CONCLUSIONS AND IMPLICATIONS: High-risk prescribing is common in those living with dementia and varies by sociodemographic factors. Regular, targeted medication reviews are needed to ensure quality use of medicines in this population.