Potentially inappropriate prescribing detected by STOPP-START criteria: are they really inappropriate?

• Published in: Age and ageing 2015-09, Vol.44 (5), p.861-866
• Main Authors: Lozano-Montoya, Isabel, Vélez-Diaz-Pallarés, Manuel, Delgado-Silveira, Eva, Montero-Errasquin, Beatriz, Cruz Jentoft, Alfonso Jose
• Format: Article
• Language: English
• Subjects: Aged, 80 and over; Disability Evaluation; Drug Interactions; Drug-Related Side Effects and Adverse Reactions - etiology; Drug-Related Side Effects and Adverse Reactions - prevention & control; Female; Geriatric Assessment; Geriatrics; Geriatrics - standards; Guideline Adherence; Hospitals, University; Humans; Inappropriate Prescribing - prevention & control; Male; Medical treatment; Medication Reconciliation; Odds Ratio; Older people; Patient Care Team; Patient Discharge; Practice Guidelines as Topic; Practice Patterns, Physicians; Risk Assessment; Risk Factors; Spain
• ISSN: 0002-0729; 1468-2834
• DOI: 10.1093/ageing/afv079

the STOPP-START criteria were developed to detect potentially inappropriate prescribing (PIP) in older people. The reasons why multidisciplinary geriatric teams decide not to follow STOPP-START criteria have not been studied. to analyse compliance with the recommendations of the STOPP-START criteria in older inpatients. ambispective, non-randomised study. SUBJECTS SETTING: three hundred and eighty-eight consecutive patients aged 80 years or over admitted to the acute geriatric medicine unit of a University hospital. STOPP-START criteria were systematically used by a pharmacist to assess pre-admission treatments, and the multidisciplinary geriatric team decided what drugs were recommended after discharge. Two researches independently assessed how many STOPP-START recommendations were accepted by the team, and if they were not accepted, why. two hundred and eighty-four PIPs were identified (0.8 per subject) according to STOPP criteria. Two hundred and forty-seven of these prescriptions (87.0%) were discontinued at discharge. STOPP recommendations were not accepted in 37 cases, mostly because the team considered other therapeutic priorities (lorazepam, n = 12; risperidone, n = 5; other, n = 18). Three hundred and ninety-seven PIPs were identified according to START criteria (1.1 per subject). START recommendations were not followed at discharge in 264 cases (66.5%). The most frequent reasons were as follows: severe disability (n = 90), the use of other effective treatments for the condition (n = 38) and high risk of severe adverse effects (n = 32). Not following START criteria was significantly associated with dependency for basic activities of daily living (ADLs) (odds ratio, OR: 0.66 for compliance with a recommendation; 0.49-0.89), dependency for instrumental ADLs (OR: 0.64; 0.48-0.85) or inability to walk (OR: 0.72; 0.54-0.98). potentially inappropriate drugs are usually discontinued, but many older hospitalised patients do not receive potentially recommended medications. More research on the reasons and consequences of this fact is needed.