Development and Validation of Prescribing Appropriateness Criteria (PAC) for Sri Lankan Older Adults.

Inappropriate prescribing in Sri Lankan older adults, contributes to adverse drug events, hospital admissions and increased healthcare expenditure. Although international tools exist to assess prescribing appropriateness in older adults, their direct application in Sri Lanka is limited by differences in clinical practices, resource constraints and variability in medicine availability. We aimed to develop and validate country-specific prescription appropriateness criteria for Sri Lankan older adults, focusing on prevalent diseases. A literature review was conducted to develop a preliminary list of criteria, which was scrutinised by three internal reviewers. The criteria were then validated using the RAND/UCLA Appropriateness Method (RAM). A multidisciplinary Sri Lankan panel (medical specialists, hospital pharmacists and pharmacy academics) completed three rounds of ratings involving 15, 11 and 7 panellists, respectively. The preliminary list contained 38 criteria; all were rated appropriate in round one, with clarity amendments suggested for seven criteria. Two additional criteria were proposed and accepted, producing a final set of 40 criteria. The criteria most frequently addressed medicines used for cardiovascular disease and diabetes mellitus, with additional focus on pain, musculoskeletal and bone health, asthma and neuropsychiatric disorders. Criteria not commonly included in international tools covered gabapentinoid prescribing for pain with renal dose adjustment, corticosteroid-associated glycaemic monitoring with antihyperglycaemic dose adjustment and blood monitoring requirements for methotrexate therapy. These criteria provide a context-specific framework to support safer prescribing for older adults in Sri Lanka. Their integration into clinical practice and pharmacist-led medication reviews could reduce medication-related problems and improve outcomes.