OBJECTIVE: Explicit screening tools and implicit evaluation methods have been developed to assist healthcare professionals in the management of pharmacotherapy in older adults. As prescribing habits and locally available medications vary considerably between countries, guides tailored to the needs of specific regions may be required. We aimed to report the results of the international Delphi validation study for the Turkish Inappropriate Medication use in the Elderly (TIME) criteria set, which aims to detect inappropriate prescribing in older adults in Eastern Europe. METHODS: The study was conducted between June 2019 and March 2020. Delphi rounds were conducted by the TIME international working group, which included 11 internationally recognized experts in geriatric pharmacotherapy as Delphi panelists. They were asked to indicate to what extent they agreed or disagreed with each TIME criterion, taking into account both the available evidence and their own experience. We used a five-point Likert scale from 1 (strongly agree) to 5 (strongly disagree) and an online software program (SurveyMonkey®) to grade the level of agreement. Criteria with a median value of 1 or 2 and a 75th centile value of 1 or 2 were accepted, and criteria with a median value > 2 were rejected. Those with a median value of 1 or 2 but a 75th centile value > 2 were retained, to be assessed in the following round. The initial list of Delphi criteria comprised 153 TIME items. RESULTS: After three Delphi rounds, 134 criteria were accepted and seven criteria were rejected, while 12 criteria did not achieve consensus, and so were not included in the final validated set of TIME criteria. CONCLUSION: We developed the internationally validated TIME criteria set based on a Delphi process involving international experts. The validation study suggests that the TIME criteria set can be applied in both central and Eastern European settings. Further studies are needed to assess the utility and benefit of the TIME criteria in reducing inappropriate drug use and improving clinical outcomes.

4th Medical Department Medical Faculty Mannheim University Medical Center Heidelberg University Mannheim Germany

Center for Appropriate Medication Use Sheba Medical Center and Deputy Head Homecare Hospice Israel Cancer Association 55 Ben Gurion Road Bat 5932210 Yam Israel

Department of Cardiovascular Endocrine metabolic Diseases and Aging Istituto Superiore di Sanità Rome Italy

Department of Geriatrics 1st Faculty of Medicine Charles University Prague Czech Republic

Department of Internal Medicine Geriatrics Amsterdam Public Health Research Institute Amsterdam University Medical Center Amsterdam The Netherlands

Department of Public Health Istanbul Medical School Istanbul University Capa 34390 Istanbul Turkey

Department Pharmaceutical Sciences Faculty of Medicine and Pharmacy Vrije Universiteit Brussel Laarbeeklaan 103 1090 Jette Belgium

Division of Geriatrics Department of Internal Medicine Istanbul Medical School Istanbul University Capa 34390 Istanbul Turkey

East Kent Hospitals University NHS Foundation Trust Ethelbert Road Canterbury Kent CT1 3NG UK

Faculty of Health and Social Sciences South Bohemian University České Budějovice Czech Republic

Geriatric Center Ulm Alb Donau Agaplesion Bethesda Ulm Geriatric Research Ulm University Ulm Germany

Medical Faculty Mannheim Institute of Clinical Pharmacology Ruprecht Karls University Heidelberg Heidelberg Germany

Section of Geriatrics Department of Internal Medicine and Paediatrics Ghent University Ghent Belgium

Servicio de Geriatría Hospital Universitario Ramón y Cajal Madrid Spain

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