Reducing Medication-Related Inappropriateness (MRI) in Older Adults: A Systematic Review and Meta-Analysis

Article

Kim, Jeong-ah, Terry, Daniel and Nguyen, Hoang. 2025. "Reducing Medication-Related Inappropriateness (MRI) in Older Adults: A Systematic Review and Meta-Analysis." Journal of Patient Safety. https://doi.org/10.1097/PTS.0000000000001406
Article Title

Reducing Medication-Related Inappropriateness (MRI) in Older Adults: A Systematic Review and Meta-Analysis

ERA Journal ID201107
Article CategoryArticle
AuthorsKim, Jeong-ah, Terry, Daniel and Nguyen, Hoang
Journal TitleJournal of Patient Safety
Number of Pages8
Year2025
PublisherLippincott Williams & Wilkins
Place of PublicationUnited States
ISSN1549-8417
1549-8425
Digital Object Identifier (DOI)https://doi.org/10.1097/PTS.0000000000001406
Web Address (URL)https://journals.lww.com/journalpatientsafety/abstract/9900/reducing_medication_related_inappropriateness.379.aspx
Abstract

Objectives: Medication-Related Inappropriateness (MRI) poses a significant risk to elderly patients, particularly in aged care settings, where complex medication regimens and healthcare challenges increase the likelihood of errors. Addressing MRI is critical to enhancing patient safety and improving health outcomes for older adults. This study aims to evaluate the effectiveness of interventions designed to reduce MRI and improve prescribing practices in elderly populations through a systematic review and meta-analysis.
Methods: A systematic review and meta-analysis were conducted following the Cochrane Handbook for Systematic Reviews of Interventions. Databases including MEDLINE, EMBASE, CINAHL, PubMed and EBSCOhost were searched from April 2020 to November 2023. Randomised controlled trials (RCTs) and non-randomised controlled studies evaluating interventions for reducing MRI in elderly patients receiving care in various healthcare settings were included. Eight studies involving a total of 33,170 participants across seven countries qualified for analysis. The pooled odds ratio (OR) with a 95% confidence interval (CI) was calculated to measure intervention effectiveness. Statistical heterogeneity was assessed using the Higgins I² statistic, and a random-effects model was applied to account for variability.
Results: Interventions ranged from educational programs and peer reviews to computerised decision-support systems. The meta-analysis demonstrated a significant reduction in MRI, with a pooled OR of 0.43 (95% CI: 0.31–0.60), indicating a 57% reduction in inappropriate prescribing. Educational interventions were particularly effective, fostering improved prescriber behavior and medication safety. However, high heterogeneity (I² = 92%) underscored variations in patient demographics, care settings, and intervention designs.
Conclusions: Educational interventions and decision-support systems are found to significantly reduce the inappropriate prescribing of medication in older patients. More research is required to address variability, determine long-term outcomes, and facilitate broader implementation to improve medication safety.

KeywordsMedication-Related Inappropriateness; Patient safety; Potentially Inappropriate Prescription; Elderly patients; Potentially Inappropriate Medication; Potentially Inappropriate Medication Administration; Medication error
Contains Sensitive ContentDoes not contain sensitive content
ANZSRC Field of Research 2020420317. Patient safety
4205. Nursing
Public Notes

This is a non-final version of an article published in final form in Journal of Patient Safet: https://doi.org/10.1097/PTS.0000000000001406, 2025.

Byline AffiliationsCharles Sturt University
School of Nursing and Midwifery
Centre for Health Research
University of Tasmania
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Television as a Career Motivator and Education Tool: A Final-Year Nursing Student Cohort Study
Terry, Daniel and Peck, Blake. 2020. "Television as a Career Motivator and Education Tool: A Final-Year Nursing Student Cohort Study." European Journal of Investigation in Health Psychology and Education. 10 (1), pp. 346-357. https://doi.org/10.3390/ejihpe10010026
Supervision in Healthcare: A Critical Review of the Role, Function and Capacity for Training
Terry, Daniel, Nguyen, Hoang, Perkins, Alicia J and Peck, Blake. 2020. "Supervision in Healthcare: A Critical Review of the Role, Function and Capacity for Training." Universal Journal of Public Health. 8 (1), pp. 1-14. https://doi.org/10.13189/ujph.2020.080101
Public perception of medical errors: Experiences and risks shared in Australia
Kim, Jeong-ah, Terry, Daniel, Jang, Sunny, Nguyen, Hoang, Gilbert, Julia and Cruickshank, Mary. 2020. "Public perception of medical errors: Experiences and risks shared in Australia." Universal Journal of Public Health. 8 (1), pp. 35-41. https://doi.org/10.13189/ujph.2020.080104
Communities of Practice: A systematic review and meta-synthesis of what it means and how it really works among nursing students and novices
Terry, Daniel R., Nguyen, Hoang, Peck, Blake, Smith, Andrew and Phan, Hoang. 2020. "Communities of Practice: A systematic review and meta-synthesis of what it means and how it really works among nursing students and novices." Journal of Clinical Nursing. 29 (3-4), pp. 370-380. https://doi.org/10.1111/jocn.15100
A critical appraisal of what organisational approaches are pivotal to improve patient safety.
Kim, Jeong-ah, Terry, Daniel, Jang, Sunny, Gilbert, Julia and Cruickshank, Mary. 2020. "A critical appraisal of what organisational approaches are pivotal to improve patient safety. " Journal of Hospital Administration. 9 (1), pp. 26-34. https://doi.org/10.5430/jha.v9n1p26
The data deficit for asthma emergency presentations might surprise you: How RAHDaR addresses the data chasm.
Terry, Daniel R T, Peck, Blake and Kloot, Kate. 2020. "The data deficit for asthma emergency presentations might surprise you: How RAHDaR addresses the data chasm. " Rural and Remote Health. 20 (2). https://doi.org/10.22605/RRH5776
What Australian Nursing Students Value as Important in Undertaking Rural Practice
Terry, Daniel R., Peck, Blake, Smith, Andrew, Stevenson, Tyrin, Nguyen, Hoang and Baker, Ed. 2020. "What Australian Nursing Students Value as Important in Undertaking Rural Practice ." Online Journal of Rural Nursing and Health Care. 20 (1), pp. 32-56. https://doi.org/10.14574/ojrnhc.v20i1.589
Understanding childhood injuries in rural areas: Using Rural Acute Hospital Data Register to address previous data deficiencies
Peck, Blake, Terry, Daniel R and Kloot, Kate. 2020. "Understanding childhood injuries in rural areas: Using Rural Acute Hospital Data Register to address previous data deficiencies." Emergency Medicine Australasia. 32 (4), pp. 646-649. https://doi.org/10.1111/1742-6723.13565
A Narrative Synthesis of Childhood Injury Prevention Programs for Pre-School Children
Peck, Blake, Terry, Daniel and Ervin, Kaye. 2020. "A Narrative Synthesis of Childhood Injury Prevention Programs for Pre-School Children." Universal Journal of Public Health. 8 (6), pp. 193-197. https://doi.org/10.13189/ujph.2020.080602
Workplace Based Assessment Program for International Medical Graduates: An Evaluation of an Australian Trial Site
Terry, Daniel, Peck, Blake and Gazula, Swapnali. 2020. "Workplace Based Assessment Program for International Medical Graduates: An Evaluation of an Australian Trial Site." Universal Journal of Public Health. 8 (6), pp. 198-206. https://doi.org/10.13189/ujph.2020.080603
Occupational Self-Efficacy and Psychological Capital Amongst Nursing Students: A Cross Sectional Study Understanding the Malleable Attributes for Success
Terry, Daniel, Peck, Blake, Smith, Andrew and Nguyen, Hoang. 2020. "Occupational Self-Efficacy and Psychological Capital Amongst Nursing Students: A Cross Sectional Study Understanding the Malleable Attributes for Success." European Journal of Investigation in Health Psychology and Education. 10 (1), pp. 159-172. https://doi.org/10.3390/ejihpe10010014
Traversing the Funambulist’s Fine Line between Nursing and Male Identity: A Systematic Review of the Factors that Influence Men as They Seek to Navigate the Nursing Profession
Terry, Daniel, Peck, Blake, Carden, Clarissa, Perkins, Alicia J. and Smith, Andrew. 2020. "Traversing the Funambulist’s Fine Line between Nursing and Male Identity: A Systematic Review of the Factors that Influence Men as They Seek to Navigate the Nursing Profession ." European Journal of Investigation in Health Psychology and Education. 10 (3), pp. 691-703. https://doi.org/10.3390/ejihpe10030051
Chronic ill health in a regional Victoria setting: A 13-year comparison
Glenister, Kristen, Bourke, Lisa, Terry, Daniel and Simmons, David. 2019. "Chronic ill health in a regional Victoria setting: A 13-year comparison." Australian Journal of Rural Health. 27 (6), pp. 527-534. https://doi.org/10.1111/ajr.12565
Communication training and its effects on carer and care-receiver outcomes in dementia settings: A systematic review
Nguyen, Hoang, Terry, Daniel, Phan, Hoang, Vickers, James and McInerney, Fran. 2019. "Communication training and its effects on carer and care-receiver outcomes in dementia settings: A systematic review ." Journal of Clinical Nursing. 28 (7-8), pp. 1050-1069. https://doi.org/10.1111/jocn.14697
Acute circulatory complications in people with diabetes mellitus type 2: How admission varies between urban and rural Victoria
Gardiner, Gardiner, Robins, Shalley and Terry, Daniel. 2019. "Acute circulatory complications in people with diabetes mellitus type 2: How admission varies between urban and rural Victoria." Australian Journal of Rural Health. 27 (1), pp. 49-56. https://doi.org/10.1111/ajr.12459
Health professional students' rural placement satisfaction and rural practice intentions: A national cross-sectional survey
Smith, Tony, Sutton, Keith, Sabrina, Pit, Muyambi, Kuda, Terry, Daniel, Farthing, Annie, Courtney, Claire and Cross, Merylin. 2018. "Health professional students' rural placement satisfaction and rural practice intentions: A national cross-sectional survey." Australian Journal of Rural Health. 26 (1), pp. 26-32. https://doi.org/10.1111/ajr.12375
Competing food consumption discourses and proper gendered behaviour among over 50s: are you really what you eat?
Malatzky, Christina, Terry, Daniel, Bourke, Lisa, Glenister, Kristen and Ervin, Kaye. 2018. "Competing food consumption discourses and proper gendered behaviour among over 50s: are you really what you eat?" Journal of Research for Consumers. 32, pp. 1-31.
Asthma hospitalisation trends from 2010 to 2015: variation among rural and metropolitan Australians
Terry, Daniel, Robins, Shalley, Gardiner, Samantha, Ruby, Wyett and Islam, Md Rafiqul. 2017. "Asthma hospitalisation trends from 2010 to 2015: variation among rural and metropolitan Australians." BMC Public Health. 17. https://doi.org/10.1186/s12889-017-4704-y