Potential inappropriate prescribing among ambulatory elderly patients in a geriatric centre in southwestern Nigeria: Beers criteria versus STOPP/START criteria

Wuraola Akande-Sholabi,Lawrence A Adebusoye,Oluwatobi C Ajilore,Segun J Showande

doi:10.4314/tjpr.v19i5.29

Wuraola Akande-Sholabi, Lawrence A Adebusoye + Show 2 more

Open Access

https://doi.org/10.4314/tjpr.v19i5.29

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Abstract

Purpose: To identify potentially inappropriate prescribing in ambulatory elderly patients and compare the appropriateness of guidelines; Beers' and Screening Tool of Older Person’s Prescription (STOPP)/Screening Tool to Alert Right Treatment (START) criteria to detect potentially inappropriate prescribing among the elderly.Methods: A retrospective study was conducted using case files of 335 elderly patients aged ≥ 60 years between 1st January and 31st December 2016, using a data extraction sheet. The 2015 American Geriatrics Society (AGS)-Beers Criteria, and version 2 of the STOPP and START were subsequently used to identify the Potentially Inappropriate Prescribing (PIP) and Potential Prescribing Omissions (PPOs).Results: Mean age of patients was 69 ± 0.4 years (range 60 - 85 years) and 219 (65.4 %) were females. An average of 4.2 medications per patient prescription was found. The Beers criteria identified 26.5 % PIP, while STOPP criteria identified 57.1 % PIP. START detected 29 PPOs in 15 (4.4 %) of the patient’s prescription. The most prevalent disease conditions were hypertension 235 (70.1 %) and osteoarthritis 64 (19.3 %). Polypharmacy was significantly associated with PIP in both Beers (p = 0.002) and STOPP (p = 0.001) criteria.Conclusion: The prevalence of PIP is high among elderly patients. The STOPP/START criteria identified a higher proportion of PIP among elderly patients compared with Beers criteria. The frequency of PIP should stimulate efforts to curtail potentially inappropriate prescribing and may require the need for advocating for a national criterion to be adopted by health care professionals in Nigeria. Keywords: Potential inappropriate prescribing, Beers’ criteria, STOPP/START criteria, Elderly

Highlights

The elderly are the fastest growing population subgroup globally, with almost two-third living in developing countries [1]
Since there is no criteria outlining the use of medication appropriately or inappropriately among the elderly in the country, this study evaluated the prevalence of potential inappropriate prescribing (PIP) and potentially inappropriate medications (PIMs) in the elderly using both the American Geriatrics Society (AGS)/Beers criteria and Screening Tool of Older Person’s Prescription (STOPP)/Screening Tool to Alert Right Treatment (START) with a view to advocating for a criteria that can be adapted for the country
Hypertension 235 (70.1 %) was the most prevalent disease state found in the elderly followed by osteoarthritis 64 (19.3 %) and diabetes 19 (5.8 %)

Summary

Introduction

The elderly are the fastest growing population subgroup globally, with almost two-third living in developing countries [1]. According to United Nations projection, the elderly population aged 60 years and above in Nigeria is expected to increase to approximately 26 million from 6.98. Nigeria is at the lead of this growing age bracket, with approximately 7.0 % of Nigerians in the elderly age group in 2014 [4]. Polypharmacy is known to lead to the use of potentially inappropriate medications (PIMs) [8,9]. These are medications with greater risk of intolerance related to adverse pharmacodynamics, pharmacokinetics or drugdisease interactions when used in the elderly [10]

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