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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

[ Vol. 12 , Issue. 2 ]

Author(s):

Roger E. Thomas* and Bennett C. Thomas   Pages 121 - 154 ( 34 )

Abstract:


Background: Polypharmacy remains problematic for individuals ≥65.

Objective: To summarise the percentages of patients meeting 2015 STOPP criteria for Potentially Inappropriate Prescriptions (PIPs), 2015 Beers criteria for Potentially Inappropriate Medications (PIMs), and START criteria Potential Prescribing Omissions (PPOs).

Methods: Searches conducted on 2 January 2019 in Medline, Embase, and PubMed identified 562 studies and 62 studies were retained for review. Data were abstracted independently.

Results: 62 studies (n=1,854,698) included two RCTs and 60 non-randomised studies. For thirty STOPP/START studies (n=1,245,974) average percentages for ≥1 PIP weighted by study size were 42.8% for 1,242,010 community patients and 51.8% for 3,964 hospitalised patients. For nineteen Beers studies (n = 595,811) the average percentages for ≥1 PIM were 58% for 593,389 community patients and 55.5% for 2,422 hospitalised patients. For thirteen studies (n=12,913) assessing both STOPP/START and Beers criteria the average percentages for ≥1 STOPP PIP were 33.9% and Beers PIMs 46.8% for 8,238 community patients, and for ≥ 1 STOPP PIP were 42.4% and for ≥1 Beers PIM 60.5% for 4,675 hospitalised patients. Only ten studies assessed changes over time and eight found positive changes.

Conclusion: PIP/PIM/PPO rates are high in community and hospitalised patients in many countries. RCTs are needed for interventions to: reduce new/existing PIPs/PIMs/PPO prescriptions, reduce prescriptions causing adverse effects, and enable regulatory authorities to monitor and reduce inappropriate prescriptions in real time. Substantial differences between Beers and STOPP/START assessments need to be investigated whether they are due to the criteria, differential medication availability between countries, or data availability to assess the criteria.

Keywords:

Potentially inappropriate prescriptions, potential prescribing omissions, inappropriate prescribing, polypharmacy, medication errors, STOPP/START 2015 criteria, American Geriatrics Society Beers 2015 criteria, systematic review.

Affiliation:

Department of Family Medicine, Faculty of Medicine, Health Sciences Centre, 3330 Hospital Drive NW, University of Calgary, Calgary, Alberta, T2N 4N1, Independent Researcher, 1604 21 Avenue, NW, Calgary, Alberta, T2M1M1

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