Assessing Medication Problems in those ≥ 65 Using the STOPP and START Criteria

Area of Science:

• Geriatric pharmacotherapy
• Medication safety in older adults
• Evidence-based prescribing

Background:

• Polypharmacy presents a significant challenge for individuals aged 65 and older.
• Identifying and addressing medication-related issues is crucial for this demographic.

Purpose of the Study:

• To summarize the prevalence of Potentially Inappropriate Medications (PIMs) using the STOPP criteria.
• To determine the rates of Potential Prescribing Omissions (PPOs) identified by the START criteria in individuals aged 65 and above.

Main Methods:

• Systematic literature search of databases (Medline, Embase) from 1980 to December 2015.
• Analysis of studies reporting PIMs and PPOs using STOPP/START criteria in diverse geriatric populations.
• Inclusion of data from large national outpatient databases and smaller community, hospital, and nursing home studies.

Main Results:

• High weighted average rates of PIMs (26-59%) and PPOs (24-50%) were observed across different settings (community, hospital, nursing home).
• Common PIMs included benzodiazepines, proton pump inhibitors, NSAIDs, aspirin, and duplicate medications.
• Key PPOs involved omissions of medications for cardiovascular diseases, hypertension, osteoporosis, diabetes, and hyperlipidemia.

Conclusions:

• The prevalence of PIMs and PPOs among older adults is substantial.
• Current STOPP/START criteria rely on expert consensus; future research should focus on evidence-based guidelines and RCTs.
• Further research is needed to validate criteria and assess their impact on reducing medication errors and hospital admissions.