Inappropriate prescribing in the elderly: A comparison of two validated screening tools

Abstract

BackgroundBetween 25% and 40% of hospital admissions in elderly patients may be linked to drug-related problems. Therefore prevention and recognition of inappropriate prescribing of medicines in elderly patients is one of the principle health care quality and safety issues. AimTo identify and compare the rate of inappropriate prescribing in elderly patients using two validated screening tools: STOPP/START criteria and Beers criteria. Materials and methodsA cross-sectional observational study on prescriptions of 600 patients aged ≥65 years was conducted. STOPP/START criteria and Beers criteria were applied to detect inappropriate prescriptions. Feedback was obtained from clinicians about measures to reduce potentially inappropriate prescriptions (PIPs) and related adverse drug events. ResultsThere were 19.8% and 7.3% PIPs found using STOPP/START criteria and Beers criteria, respectively. The most commonly found PIP with both criteria was the prescribing of calcium channel blockers among hypertensive patients with chronic constipation. Of the 19.8% PIPs found with STOPP/START criteria, 7% were potential prescribing omissions, the most common of which was statins not prescribed for diabetic patients with multiple cardiovascular risk factors. STOPP/START criteria detected more of PIPs in inpatients than outpatients. Polypharmacy and increasing age were important risk factors for PIPs. Most of the clinicians agreed that monitoring of adverse drug reactions would be helpful. ConclusionThe STOPP/START criteria detected more PIPs compared with the commonly used Beers criteria. Application of such screening tools to prescribing decisions may reduce unnecessary medication, related adverse events, hospital admissions, and cost.