Inappropriate Medication Use in the Elderly

Abstract

STOPP (Screening Tool of Older Persons' Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment) are relatively new, validated tools that increasingly are used together to identify prescribing errors in elderly patients. This article reviews two studies that have directly compared STOPP with the Beers criteria, which is the current standard tool used to identify potentially inappropriate medications (PIMs) in older patients. Both studies reveal greater correlations to adverse drug events (ADEs) with PIMs defined by STOPP than with those defined by the Beers criteria, suggesting STOPP may be more useful in practice. Additional studies are needed to confirm STOPP's greater sensitivity and to determine whether its use translates to improved patient outcomes such as decreased morbidity, mortality, and health care costs. If so, pharmacists should consider implementation of STOPP (with or without START) in practice to improve care for the elderly population.

<p>Relationship Between Potentially Inappropriate Medications And The Risk Of Hospital Readmission And Death In Hospitalized Older Patients</p>

“…To deal with this problem, the United States proposed the concept of the use of potentially inappropriate medications (PIMs) in the elderly patients in 1991 and established Beers criteria,2 which were revised four times until 2015 3. The US studies showed that PIM use among elderly patients was 42.6–49.0%,4,5 and patients taking PIMs had an increased incidence of adverse drug events, emergency, and readmission to hospital 6,7. The risk of hospital admission for patients taking more than three PIMs at the same time was 1.6 times that of patients taking no PIMs 8.…”

Evaluation of potentially inappropriate prescribing and deprescription as elements of good medical practice in elderly patient care

“…Safety of medication in polypharmacy is a serious and complex issue [24], as polypharmacy often leads to elevated risk of drug relative overdose or interactions that are sometimes difficult to foresee [25], especially in older patients already limited organ function reserve [26]; it can also cause lowered physical or mental capabilities [27], excessive or prolonged hospitalization [28], and even deaths [29], often presenting as preventable medication errors [30]. Potentially inappropriate medications (PiM) [31] and improper prescribing can be identified and judged using objective means, such as beer's criteria [32], the improved Prescribing in the Elderly Tool (iPET) [33], and their apparently more sensitive successors [34], the Screening Tool of older Persons' Potentially inappropriate Prescriptions (SToPP) [35] or the Screening Tool to Alert doctors to right Treatment (STArT) [36]. The prevalence of this type of medical error is significantly underestimated [37], as medication errors are more commonly associated with isolated incidents of administering the wrong drug or dosage of a drug [38], which rarely leads to acute adverse health effects or death, and not with the more widespread polypharmacy, despite the fact that such incidents are quite common and the vast majority go unnoticed [39].…”