Assessing Medication Problems in those ≥ 65 Using the STOPP and START Criteria

Author(s): Roger E. Thomas

Journal Name: Current Aging Science

Volume 9 , Issue 2 , 2016

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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 criteria.

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. yielded 180 citations, 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. yielded 427 citations and 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.

Keywords: STOPP and START criteria, polypharmacy, individuals ≥ 65, patients in the community, hospitals and nursing homes, drug-related, drug safety, side effects, adverse reactions

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Article Details

Year: 2016
Published on: 16 February, 2016
Page: [150 - 158]
Pages: 9
DOI: 10.2174/1874609809999160217101716
Price: $65

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