Background: Polypharmacy is a key problem for those ≥65.
Objective: To summarise for individuals ≥65 the rates of Potentially Inappropriate Medications
(PIMs) identified by application of STOPP, and Potential Prescribing Omissions (PPOs) by START
Methods: Search: Databases were searched 1980 to 1 December 2015. For Medline the search
yielded 3,691 systematic reviews or meta-analyses and 301 when limited to 65 years and over.
STOPP.mp yielded 180 citations, START.mp 109,132 and 105 when limited to both. For Embase the
search yielded 24,681 systematic reviews or meta-analyses, and 881 when limited to 65+ years. STOPP.mp yielded 427
citations and START.mp 147,322, and 327 when limited to both.
Results: Search: identified 28 studies with data and plus a systematic review using STOPP/START criteria. For community
dwelling-individuals for national outpatient databases (n=1,528,785) PIMs weighted average was 31%, PPOs 47%.
For small community studies (n=2,228) PIMs weighted average was 26%, PPOs 24%. For hospitalised patients (n=4,237)
PIMs weighted average was 47%, PPOs 50%. For nursing home patients PIMs weighted average (n=1,539 patients) was
59%, PPOs (n=463 residents) 49%. Principal PIMs were benzodiazepines, proton pump inhibitors, NSAIDs, aspirin, and
duplicate medications. Principal PPOs were omissions of medications for cardiovascular diseases, hypertension, osteoporosis,
diabetes and hyperlipidemia.
Conclusions: Rates of PIMs and PPOs are high. Criteria are currently based on expert consensus. Next steps are to link
criteria to the best internationally-accepted evidence-based systematic reviews/guidelines and conduct RCTs to test
whether application of the criteria leads to lower rates of medication errors and hospital admissions.