Analysis of therapeutic appropriateness in the elderly according to the Beers criteria, STOPP and START

Abstract

Introduction.– Tools have been developed to identify potentially inappropriatemedications (PIM) in elderly, aswell as potential prescribing omissions (PPO). The purpose of the study was to analyze the therapeutic appropriateness in the hospitalized elderly. Methods.– Were retrospectively selected 150 patients, with ≥65years, admitted to InternalMedicineward, between 1 July and 31 December, 2011. Thirty-three were excluded. The Beers criteria (2012), STOPP and START were applied at admission and clinical discharge. Results.–Onehundredand seventeenpatientswere analyzed.Mean age: 81.2 years. Average drugs per patient: 7.2 at admission, 6.8 at discharge. Major polypharmacy (≥5 drugs): 81.2% at admission; 82.9% at discharge. In the Beers criteria, were detected at admission 127 PIM (1.09/patient), and 125 PIM (1.07/patient) at discharge, of which 38.9% and 48.0% respectively were benzodiazepines (BZD). PIM due to drug–disease/syndrome interactions: 80 at entrance, 73 at discharge, especially in dementia (37.5% and 39.7% respectively). PIM to be usedwith caution: 83 at entrance, 74 at discharge. STOPP criteria: detected 143 PIM (1.22/patient) at admission and 113 (0.97/patient) at discharge, representing a decrease of 30 PIM. The long-term BZD represented 26.6% of PIM at entrance and 38.9% at discharge. START criteria detected 195 PPO (1.67/patient), 38.5% were regarding to cardiovascular system; occurring a decrease of 42.1% PPO at discharge. Conclusions.– The tools identified a significant number of PPO and PIM. Their use can contribute to reduce adverse drug events in the elderly and their associated costs.