A critical analysis of the methods used to develop explicit clinical criteria for use in older people

Older people are the biggest users of medications and with the majority of the population ageing it is important to ensure that their medications are managed properly. Many have developed explicit criteria in order to assist in making appropriate drugs choices in the older population. This paper explores whether the methods used to develop the currently available explicit criteria for appropriate prescribing in older people are applied appropriately, and if not, whether this invalidates the criteria themselves. The wide spread use of the Delphi technique to develop medical criteria indicates that the technique itself should be evaluated for its suitability in the development of criteria in older people before the criteria are themselves evaluated. A number of criteria have been reviewed and none fulfils the requirements for appropriate development. There is a need for new criteria, with transparent referencing of recommendations and rigorous final evaluation.