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Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly


Screening Tool Of Older People's Prescriptions (STOPP)
Screening Tool to Alert to Right Treatment (START)

Purpose : STOPP/START is a physiological systems-based explicit set of criteria that attempts to define the clinically important prescribing problems relating to potentially inappropriate medications (PIMs–STOPP criteria) and potential prescribing omissions (PPOs–START criteria). The previous two versions of STOPP/START criteria were published in 2008 and 2015. The 2023 version is the revised and updated third version of the criteria.

Admin time :  Highly operator dependent - 5 mins for an expert, up to 20-30 mins

User Friendly :  Moderate

Administered by : GP, Physician, Community Pharmacist


Content : Explicit criteria that facilitate medication review in multi-morbid older people in most clinical settings.


​Author : O’Mahony D et al, 31 May 2023

correction O’Mahony D et al,16 June 2023

Copyright : Open Access The source article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit


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)

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)

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.

These types of errors are prevalent in all healthcare settings.

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.

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).

The substantially greater number of STOPP/START criteria in version 3 reflects the growth in published evidence between 2014 and 2022 relating to pharmacotherapy for common disorders encountered in older people such as heart disease, diabetes, and chronic obstructive pulmonary disease (COPD). The number of STOPP criteria has increased from 80 in version 2 to 133 in version 3, an 66.25% increase. Similarly, the number of START criteria has increased from 34 in version 2 to 57 in version 3, a 67.6% increase. The overall increase of STOPP/START criteria in version 3 compared to version 2, i.e., from 114 to 190 criteria represents a 66.7% increase. The growth in the overall number of STOPP/START criteria mostly reflects an expanding evidence base over the last decade.

Although expansion of therapeutic options for the treatment of common conditions in multimorbid older people is welcome, it carries increased possibilities of drug-related problems. The additional criteria in STOPP/START version 3 largely reflect the more common and important adverse drug–drug and drug–disease interactions encountered in current clinical practice. The increased number of criteria in version 3 is intended to assist clinicians to detect and prevent greater numbers of adverse drug–drug and drug–disease interactions and their consequences during routine medication review than in previous versions of STOPP/START.

This Tool is used in the Medication Review

Back To : Medication Review

medication tablets capsules
medical assessment blood pressure measurement medication pills

The Medication Review is one of 5 sub-domains of the

 Medical Assessment

Back To : Medical Assessment

The Medical Assessment is one of 8 domains of the

 Comprehensive Geriatric Assessment (CGA)

Back To : Comprehensive Geriatric Assessment

This Tool is also used in Proactive Care 

 of the Elderly

Back To : Proactive Care

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