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A Systematic Review of Studies of the STOPP/START 2015 and American Geriatric Society Beers 2015 Criteria in Patients ≥ 65 Years


Roger E. Thomas* and Bennett C. Thomas   Pages 1 - 34 ( 34 )


BACKGROUND: Polypharmacy remains a key problem for ≥65s.

OBJECTIVE: Summarise rates of 2015 STOPP Potentially Inappropriate Prescriptions (PIPs), 2015 Beers Potentially Inappropriate Medications (PIMs), and START Potential Prescribing Omissions (PPOs).

METHODS: Searches 2 January 2019 in Medline, Embase, and PubMed independently assessed resulted in 562 full-text citations, 62 studies retained for review, data abstracted independently.

RESULTS: 62 studies (n=1,854,698) included (2 RCTs, 60 non-randomised). Average percentages of patients with ≥1 PIP/PIM/PPO were weighted by study size. For thirty STOPP/START studies (n=245,974) average PIP percentages for 1,242,010 community patients 42.8% and for 3,964 hospitalised patients 51.8%. For nineteen Beers studies (n = 595,811) for 593,389 community patients average PIM 58% and for 2,422 hospitalised patients 55.5%. For thirteen studies (n=12,913) assessing both STOPP/START and Beers for 8,238 community patients PIPs 33.9% and PIMs 46.8% and for 4,675 hospitalised patients PIPs 42.4%, and PIMs 60.5%.

Only ten studies assessed changes over time and eight found positive changes.

CONCLUSIONS: PIP/PIM/PPO rates are high. RCTs are needed of interventions to: (1) reduce new/existing PIPs/PIMs/PPO prescriptions, (2) identify and reduce prescriptions causing adverse effects, and (3) enable regulatory authorities to closely monitor inappropriate prescriptions in real time and reduce rates. The substantial differences between individual medications identified by Beers and STOPP/START need investigating whether they are due to: content of the criteria lists, 2. medication availability in individual countries, 3.if authors applied all or subsets of criteria, or 4. physician prescribing preferences.


Potentially Inappropriate Prescriptions, Potential Prescribing Omissions, STOPP/START criteria, Beers criteria, medication errors, inappropriate prescribing, systematic review


Department of Family Medicine, Faculty of Medicine, Health Sciences Centre, 3330 Hospital Drive NW, University of Calgary, Calgary, Alberta, Independent Researcher, 1604 21 Avenue, NW, Calgary, Alberta, T2M1M1

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