Polypharmacy and inappropriate prescribing (including potential prescribing omissions) are risk factors for adverse drug reactions, which commonly cause adverse clinical outcomes in older people.(Atkin PA,1999) (Beers MH,1991)

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The elderly (aged 65 and above) are particularly vulnerable to adverse drug reactions due to changes in physiology with age and multiple comorbidities. (Byrne S,2008) (Fick DM,2003)

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Adverse drug reactions account for 30% of all hospital admissions in the elderly. (Gallagher PF, 2011)

They have been shown to contribute significantly to emergency department attendances, in-hospital morbidity/mortality (Gallaghr PF, 2011) and new hospital admissions.

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These types of errors are prevalent in all healthcare settings.

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Studies in Ireland have shown that inappropriate prescribing of one or more drugs was prevalent in 21% of patients in the primary care setting, (Hanlon JT, 1997) 35% in the acute hospital setting, (Hill-Taylor B, 2016) and 60% in nursing home care.(Hill-Taylor B, 2016).

These studies have also revealed that serious prescribing omissions were even more prevalent, with 58% of patients in hospitals and 23% of patients in primary care not being prescribed appropriate medication for their comorbidities.

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The Beers criteria were developed in 1991 to help tackle inappropriate prescribing in the elderly nursing home population.(Hutchison LC, 2007)

It was widely used but found to have limitations, as several of the drugs were no longer in use in Europe and others were no longer contraindicated in elderly people.

Furthermore, the Beers criteria did not account for prescribing omissions.(Lazarou J,1998).

 

In 2010, a new criterion for inappropriate prescribing in the elderly was created, which was explicitly designed to be used in the clinical setting and found to be more sensitive than the Beers criteria.(NICE, 2015).

It is known as the Screening Tool of Older Persons’ Prescriptions (STOPP) and Screening Tool to Alert to Right Treatment (START) criteria and was revised in 2014 (O'Mahoney D, 2015).

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The STOPP/START criteria are composed of a total of 114 criteria, 80 STOPP and 34 START, which were formed, using a Delphi consensus methodology, by a panel of doctors, pharmacists, pharmacologists and primary care physicians with expertise in geriatric medicine and pharmacotherapy in the elderly population from 13 countries in Europe.(Lazarou J,1998).

 

The 80 STOPP and 34 START criteria are grouped by a physiological system (e.g. the cardiovascular system, central nervous system) and accompanied by a short explanation of the interaction.

 

The STOPP/START criteria have since been successfully applied in a number of settings.

A randomised controlled trial showed that using the STOPP/START criteria as an intervention significantly improved medication appropriateness and reduced prescribing omissions in older people hospitalised for acute illness.(O'Mahoney D, 2010).