Abstract
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 STARTcriteria.
Methods: Search: Databases were searched 1980 to 1 December 2015. For Medline the searchyielded 3,691 systematic reviews or meta-analyses and 301 when limited to 65 years and over.STOPP.mp yielded 180 citations, START.mp 109,132 and 105 when limited to both. For Embase thesearch yielded 24,681 systematic reviews or meta-analyses, and 881 when limited to 65+ years. STOPP.mp yielded 427citations and START.mp 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 communitydwelling-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) was59%, PPOs (n=463 residents) 49%. Principal PIMs were benzodiazepines, proton pump inhibitors, NSAIDs, aspirin, andduplicate 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 linkcriteria to the best internationally-accepted evidence-based systematic reviews/guidelines and conduct RCTs to testwhether 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 nursinghomes, drug-related, drug safety, side effects, adverse reactions
Current Aging Science
Title:Assessing Medication Problems in those ≥ 65 Using the STOPP and START Criteria
Volume: 9Issue: 2
Author(s):Roger E. Thomas
Affiliation:
Keywords:STOPP and START criteria, polypharmacy, individuals ≥ 65, patients in the community, hospitals and nursinghomes, drug-related, drug safety, side effects, adverse reactions
Abstract: 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 STARTcriteria.
Methods: Search: Databases were searched 1980 to 1 December 2015. For Medline the searchyielded 3,691 systematic reviews or meta-analyses and 301 when limited to 65 years and over.STOPP.mp yielded 180 citations, START.mp 109,132 and 105 when limited to both. For Embase thesearch yielded 24,681 systematic reviews or meta-analyses, and 881 when limited to 65+ years. STOPP.mp yielded 427citations and START.mp 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 communitydwelling-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) was59%, PPOs (n=463 residents) 49%. Principal PIMs were benzodiazepines, proton pump inhibitors, NSAIDs, aspirin, andduplicate 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 linkcriteria to the best internationally-accepted evidence-based systematic reviews/guidelines and conduct RCTs to testwhether application of the criteria leads to lower rates of medication errors and hospital admissions.
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Cite this article as:
E. Thomas Roger, Assessing Medication Problems in those ≥ 65 Using the STOPP and START Criteria, Current Aging Science 2016; 9 (2) .https://dx.doi.org/10.2174/1874609809999160217101716
| DOI https://dx.doi.org/10.2174/1874609809999160217101716 | Print ISSN 1874-6098 |
| Publisher Name Bentham Science Publisher | Online ISSN 1874-6128 |
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