Examining potentially inappropriate prescribing in residential care using the STOPP/START criteria

Abstract

IntroductionInappropriate prescribing in residential care is a particular health concern. This study aims to identify the prevalence of potentially inappropriate prescriptions (PIP) and potential prescribing omissions (PPO) in older people living in residential care in New Zealand. MethodThe STOPP/START criteria was applied to the data collected from the medical notes of people aged≥65years-old living in two residential care homes in New Zealand. Prescribed medicines were classified using the World Health Organisation Anatomic Therapeutic Classification. Charlson Comorbidity Index and Katz Activities of Daily Living were computed for each resident and included in the regression analyses. ResultsThe mean age of residents (n=137) was 85.4 (±7.7) years. In total, 205 PIPs among 102 residents (74.5%) were identified and 66 PPOs were present among 49 residents (35.8%). Antipsychotics were the most common PIPs in residents with a medium/high falls risk (18.6%). Residents with higher comorbidity scores were less likely to be taking a PIP. Residents with a medium/high falls risk were more likely to have a PIP, than those with a low falls risk. ConclusionConsistent with other countries, PIPs and PPOs were highly prevalent in older people in residential care in New Zealand. Antipsychotics, opiates and benzodiazepines accounted for approximately 50% of the 205 PIP exposures. Regarding PPO, the omission of aspirin and angiotensin converting enzyme inhibitors where clinically indicated was noted. The STOPP/START criteria could be used in multidisciplinary clinical reviews to help improve the medicine therapy in older people living in the residential care setting.