Background: Polypharmacy remains problematic for individuals ≥65.
Objective: To summarise the percentages of patients meeting 2015 STOPP criteria for Potentially
Inappropriate Prescriptions (PIPs), 2015 Beers criteria for Potentially Inappropriate Medications
(PIMs), and START criteria Potential Prescribing Omissions (PPOs).
Methods: Searches conducted on 2 January 2019 in Medline, Embase, and PubMed identified 562
studies and 62 studies were retained for review. Data were abstracted independently.
Results: 62 studies (n=1,854,698) included two RCTs and 60 non-randomised studies. For thirty
STOPP/START studies (n=1,245,974) average percentages for ≥1 PIP weighted by study size were
42.8% for 1,242,010 community patients and 51.8% for 3,964 hospitalised patients. For nineteen
Beers studies (n = 595,811) the average percentages for ≥1 PIM were 58% for 593,389 community
patients and 55.5% for 2,422 hospitalised patients. For thirteen studies (n=12,913) assessing both
STOPP/START and Beers criteria the average percentages for ≥1 STOPP PIP were 33.9% and
Beers PIMs 46.8% for 8,238 community patients, and for ≥ 1 STOPP PIP were 42.4% and for ≥1
Beers PIM 60.5% for 4,675 hospitalised patients. Only ten studies assessed changes over time and
eight found positive changes.
Conclusion: PIP/PIM/PPO rates are high in community and hospitalised patients in many countries.
RCTs are needed for interventions to: reduce new/existing PIPs/PIMs/PPO prescriptions, reduce
prescriptions causing adverse effects, and enable regulatory authorities to monitor and reduce
inappropriate prescriptions in real time. Substantial differences between Beers and STOPP/START
assessments need to be investigated whether they are due to the criteria, differential medication
availability between countries, or data availability to assess the criteria.