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BackgroundSTOPP and START criteria were developed to identify potentially inappropriate prescription (PIP) and potentially prescribing omission (PPO), and to improve the use of medication in older people.PurposeThe aim of this study was to evaluate the medical care for elderly patients in an acute geriatric department with the STOPP and START criteria.Material and methodsThis study included patients admitted to the acute geriatric department in an academic hospital from July to October 2015. Using pre-admission treatment, a pharmacist used STOPP and START criteria version 2 to identify PIPs and PPOs. After the patient’s discharge, a geriatrician and a pharmacist assessed how many STOPP and START criteria were followed according to the discharge prescription. The reason for not following STOPP/START criteria was investigated using clinical records.ResultsAmong 81 patients included, 224 PIPs were identified according to STOPP criteria, of which 168 (75%) were followed by the geriatricians. Among 56 cases of non-adherence to STOPP criteria, 50 cases (90%) presented a justified reason for this decision. Among 262 inappropriate prescriptions identified by geriatricians, 94 (36%) prescriptions were supplementary and not identified by STOPP criteria. Supplementary drugs stopped the most by geriatricians were drugs related to the cardiovascular system (n=28), mostly because the treatment was ineffective (n=7).According to START criteria, 90 PPOs were identified, of which 56 (62%) were followed by the geriatricians. Among 34 cases of non-adherence to START criteria, 27 cases (79%) presented a justified reason for this decision. Among 273 omission prescriptions identified by geriatricians, 217 prescriptions were supplementary and not identified by START criteria. The drugs started most by geriatricians were drugs related to the central nervous system (n=79), mostly because patients presented moderate pain (n=36).ConclusionIn this study, PIP and PPO STOPP and START criteria were usually followed by geriatricians. The reasons for not following the criteria were usually justified. However, cases of non-adherence to START criteria were more important than cases of non-adherence to STOPP criteria. In these cases, geriatricians added more drugs than the START criteria. More studies about following these criteria should be performed in older patients admitted to hospital, especially in others wards, without geriatricians.No conflict of interest

Proton pump inhibitors (PPIs) have become the agents of choice for acid-related diseases. In some clinical situations, PPI therapy by oral or intravenous route may be difficult especially among elderly and patients in palliative care. Off-label PPI subcutaneous injection could be the last alternative to improve patient relief, despite limited published data. We report a case of linitis plastica, peritoneal carcinomatosis and occlusive syndrome who suffered from painful regurgitations which rapidly improved after subcutaneous pantoprazole. No related adverse effects were observed during PPI therapy. Despite some limitations, this report suggests that off-label subcutaneous pantoprazole could be an interesting alternative route when intravenous infusion may be difficult or harmful for elderly and patients in palliative care. Nevertheless, clinical safety and efficiency data on larger populations are needed to validate this use in such population.

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