Background Predicated on shifts in pharmacokinetics and Cdynamics in older patients, you will find potentially improper medications (PIM) that should be avoided in patients aged??65?years. by 8.3 documented chronic analysis. 23.9?% of elderly individuals received at least one PIM prescription. Sedatives/hypnotics were the most frequent prescribed PIM-drugs (13.7?%). Mental disorders, gender and quantity of long-term medication were recognized as predictors for the probability of a PIM prescription. Common reported reasons for PIM prescription by FPs concerned limited knowledge concerning PIM, limited applicability of PIM lists in daily practice, lack of time, having no alternatives in medication, stronger patient-related factors than age that influence prescription, personal bad experiences concerning changes of medication or refusal of following prescriptions of sedative/hypnotics. Conclusions It is essential to see FPs inside a complex decision making scenario with several influencing factors on their prescribing, including: patient-oriented prioritization, FPs experiences in daily practice, FPs knowledge regarding existing recommendations and their trust in it and organizational characteristics of FPs daily medical practice. These pros and cons of PIM prescription in elderly individuals should be considered in FPs advanced teaching. Keywords: Potentially improper medication, Family doctor, Polypharmacy, Mixed methods Background The conversation of difficulties in medical care for seniors individuals (65?years and older) is focused on multimorbidity and polypharmacy. Concerning age-related changes in pharmacokinetics and -dynamics, the elderly individuals renal rate of metabolism and clearance as well as first-pass effect in the buy 1226056-71-8 liver are delayed in time. This causes different actions of drug in geriatric vs. more youthful patients because the pharmaceutical medicines remain longer in the metabolic system of the elderly [1]. Prescription of medical medicines in geriatric individuals has to consider these effects. But mostly there is no evidence regarding effect of medicines in the elderly. Medical tests for screening efficacy of medicines often exclude older individuals based on an upper-age limit, comorbid disease, reduced life expectancy, physical or mental impairments or use of medicines aiming to minimize biases on results of the study. But the results of efficacy studies that exclude older patients do hardly ever fit individuals in daily medical practice [2, 3]. Common empirical data display higher hospital admission rates in seniors patients because of adverse drug reactions or drug-drug reactions [4C6]. Concerning this and the difficulty of problems with medication for the elderly, expert groups in several countries have developed so called black lists of medicines for seniors patients, describing potentially inappropriate medication (PIM). Due to different formalities and drug markets, country specific PIM lists are necessary [7]. These country-specific lists include medicines that are associated with higher buy 1226056-71-8 risks of intolerance, buy 1226056-71-8 adverse drug reaction/events or drug-disease relationships in seniors individuals [8C14]. In Germany the first black list PRISCUS (PRerequISites for a new health Care model for elderly people with mUltiple morbiditieS) was consensually developed in 2010 2010 by an expert group of geriatrics, pharmacologists PPARgamma and family practitioners. PRISCUS currently includes 83 medicines that should be avoided or prescribed at a lower dose in seniors individuals. These recommendations are outlined with expert statements offering alternatives. In case of unavoidability of PIM prescriptions, recommendations for drug monitoring are given [15]. Rates of PIM prescriptions range worldwide between 12 and 65?% depending on the setting and the used screening tool. A systematic review identified a median PIM prescription rate of 20.5?% (interquartile range 18.1 to 25.6?%) in the primary care setting between 1950 and 2011. The evaluate included 19 studies of 11 different countries that examined PIM almost by Beers criteria [16]. Current studies examining older patient samples (imply age?>?80?years) showed prescription rates between 22.5 and 28.4?% in the primary care establishing [17, 18]. Since these rates seem to be high, it would be useful to understand the prescribing of PIM by family practitioners (FP) to generate feasible and need-oriented solutions for improvement of medical care in the elderly. In this context, more evidence is needed concerning FPs knowledge of PIM.