Table 3 SPPiRE PIP; drug groups associated with morbidity in the elderly [33]

Anticholinergic drugs

With comorbidities [35]

 • Dementia

 • Narrow angle glaucoma

 • Cardiac conduction abnormalities

 • Chronic prostatism

Exacerbation of comorbidity

Concomitant use of two or more drugs with anticholinergic properties [15]

Risk of anticholinergic toxicity

Tricyclic antidepressant as first line antidepressant [15]

Increased risk of adverse effects in older patients and alternatives available

Antimuscarinic antihistamine [15]

Benzodiazipines OR Z drugs

For longer than 4 weeks [15] [33]

Risk of sedation, confusion, impaired balance, falls.

NNT 13 and NNH 6 when used for insomnia [57]

Antipsychotics

With dementia and no psychosis [15, 33]

Increased risk of stroke, only use when all other means have failed and shortest possible dose for shortest duration [58]