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The Screening Tool of Older Person's Prescriptions (STOPP) is used to detect potentially inappropriate medication. Version 2 includes 80 criteria, whereof two can be considered implicit as their detection primarily relies on the assessor's expertise: (A1) drugs without indication and (A2) drug treatment beyond recommended duration. To explore the inter‐rater agreement for detection of explicit and implicit criteria, data on consecutive primary care patients from a previous study (n = 302, 65–99 years of age) were used, including independent assessments of the 78 explicit criteria (23 556 assessments) and the two implicit criteria (604 assessments) by two specialist physicians. Overall, 123 (0.5%) explicit and 10 (2%) implicit criteria were fulfilled according to both physicians. The positive agreement for a criterion being fulfilled was 56% for explicit and 16% for implicit criteria, with kappa values of 0.56 and 0.09. Discordant detection of furosemide and proton pump inhibitors was common using explicit and implicit criteria. [ABSTRACT FROM AUTHOR]

Abstract Objectives To estimate the frequency of potentially inappropriate prescribing (PIP) in outpatients according to STOPP/START criteria, and to identify risk factors. For this purpose, an algorithm was developed and validated in RStudio® based on the information collected in the electronic prescription. Methods The data corresponds to dispensations from two pharmacies in Spain made to patients over 18 years, over 4 years. For the analysis, only patients aged ≥ 65 years who are targeted by the STOPP/START criteria are included. The statistical programming language RStudio® was used to develop the algorithm. The STOPP criteria used as models for the implementation of the method were L2 and B12. A logistic regression analysis was performed. Results A total of 15,601 treatment plans were obtained from 2312 patients ≥ 65 years (56% women), of whom 46.6% had polypharmacy (≥ 5 drugs) and 9.3% had excessive polypharmacy (≥ 10 drugs). In this group, PIPs were detected in 57% of patients and in 38% of their treatment plans; of these PIPs the most common were those related to the use of benzodiazepines for more than 28 days (D5 criterion) in 25.9% of patients, followed by the use of opioids prescribed without an associated laxative (L2 criterion) in 13.8% and finally, drugs duplication (A3 criterion) in 5.7%. The most numerous duplications related to criterion A3 were benzodiazepines (39%) and non-steroidal anti-inflammatory drugs (37.4%). Conclusions The method developed and validated in RStudio® with different STOPP criteria allows us to analyse the pharmacological treatment of many patients using different databases and to identify those at risk of suffering a PIP according to the STOPP criteria. Our results indicate a high prevalence of PIPs in patients ≥ 65 years, with polypharmacy being the most common risk factor affecting PIP.

Objectives: To estimate the frequency of potentially inappropriate prescribing (PIP) in outpatients according to STOPP/START criteria, and to identify risk factors. For this purpose, an algorithm was developed and validated in RStudio® based on the information collected in the electronic prescription. Methods: The data corresponds to dispensations from two pharmacies in Spain made to patients over 18 years, over 4 years. For the analysis, only patients aged ≥ 65 years who are targeted by the STOPP/START criteria are included. The statistical programming language RStudio® was used to develop the algorithm. The STOPP criteria used as models for the implementation of the method were L2 and B12. A logistic regression analysis was performed. Results: A total of 15,601 treatment plans were obtained from 2312 patients ≥ 65 years (56% women), of whom 46.6% had polypharmacy (≥ 5 drugs) and 9.3% had excessive polypharmacy (≥ 10 drugs). In this group, PIPs were detected in 57% of patients and in 38% of their treatment plans; of these PIPs the most common were those related to the use of benzodiazepines for more than 28 days (D5 criterion) in 25.9% of patients, followed by the use of opioids prescribed without an associated laxative (L2 criterion) in 13.8% and finally, drugs duplication (A3 criterion) in 5.7%. The most numerous duplications related to criterion A3 were benzodiazepines (39%) and non-steroidal anti-inflammatory drugs (37.4%). Conclusions: The method developed and validated in RStudio® with different STOPP criteria allows us to analyse the pharmacological treatment of many patients using different databases and to identify those at risk of suffering a PIP according to the STOPP criteria. Our results indicate a high prevalence of PIPs in patients ≥ 65 years, with polypharmacy being the most common risk factor affecting PIP. [ABSTRACT FROM AUTHOR]

Background: Potentially inappropriate medications (PIMs) in older adults are medications in which risks often outweigh benefits and are suggested to be avoided. Worldwide, many distinct guidelines and tools classify PIMs in older adults. Collating these guidelines and tools, mapping them to a medication classification system, and creating a crosswalk will enhance the utility of PIM guidance for research and clinical practice. Methods: We used the Anatomical Therapeutic Chemical (ATC) Classification System, a hierarchical classification system, to map PIMs from eight distinct guidelines and tools (2019 Beers Criteria, Screening Tool for Older Person's Appropriate Prescriptions [STOPP], STOPP‐Japan, German PRISCUS, European Union‐7 Potentially Inappropriate Medication [PIM] list, Centers for Medicare & Medicaid Services [CMS] High‐Risk Medication, Anticholinergic Burden Scale, and Drug Burden Index). Each PIM was mapped to ATC Level 5 (drug) and to ATC Level 4 (drug class). We then used the crosswalk (1) to compare PIMs and PIM drug classes across guidelines and tools to determine the number of PIMs that were index (drug‐induced adverse event) or marker (treatment of drug‐induced adverse event) drug of prescribing cascades, and (2) estimate the prevalence of PIM use in older adults continuously enrolled with fee‐for‐service Medicare in 2018 as use cases. Data visualization and descriptive statistics were used to assess guidelines and tools for both use cases. Results: Out of 480 unique PIMs identified, only three medications—amitriptyline, clomipramine, and imipramine and two drug classes—N06AA (tricyclic antidepressants) and N06AB (selective serotonin reuptake inhibitors), were noted in all eight guidelines and tools. Using the crosswalk, 50% of classes of index drugs and 47% of classes of marker drugs of known prescribing cascades were PIMs. Additionally, 88% of Medicare beneficiaries were dispensed ≥1 PIM across the eight guidelines and tools. Conclusion: We created a crosswalk of eight PIM guidelines and tools to the ATC classification system and created two use cases. Our findings could be used to expand the ease of PIM identification and harmonization for research and clinical practice purposes. [ABSTRACT FROM AUTHOR]

Introduction: Physiological changes are seen in many systems in the body related to aging. Treatment modalities and drug prescribing processes need to be re-evaluated in the geriatric population. To elaborate on polypharmacy, the number of drugs the individual should use must also be defined effectively. Various criteria have been developed for prescribing and using drugs for elderly individuals. The most used of these criteria is called the Beers criteria. STOPP and START criteria are other criteria used. Material and Method: Our study aimed to retrospectively evaluate the prevalence of inappropriate drug use in patients aged 65 and over who were hospitalized in the Internal Medicine and Neurology Intensive Care Units of Ankara Atatürk Training and Research Hospital in terms of STOPP-START criteria. Results: Study group consists of 168 (58,3%) female and 120 (41,7%) male. A total of 727 diseases were diagnosed in 288 patients. 201 of these were "Cerebrovascular Diseases," 153 were "Hypertension." While the most common STOPP criterion main group and single criterion were antiplatelet anticoagulant agent group (35,7%), "Presence of a drug class causing duplication (Aiming optimum level with a single drug before adding a new agent) (23,2%)", respectively. At the same time, the most common START criterion main group and single criterion were cardiovascular system group (94,5%), and "Statin therapy in patients who are near the end of life or who are not older than 85 years of age, with a history of coronary, cerebral or peripheral vascular disease", respectively (70,2%). Conclusion: It is seen that the study results are generally similar to the national literature. There are partisan differences between the study results and the international literature. It is anticipated that these differences can be attributed to the diagnostic criteria used, study group selection, and study design differences. [ABSTRACT FROM AUTHOR]

Introduction: Interventions targeted towards polymedicated elderly patients suffering from multiple pathologies have been proven to be effective in improving appropriateness of prescribed medication, as well as prescribing quality, and patient safety. Aims: To estimate the prevalence of potentially inappropriate drug prescriptions (PIDPs) and to evaluate the impact of pharmaceutical interventions by a Primary Care Pharmacist (PCP) on PIDPs in chronically polymedicated patients over the age of 65 years by means of the Beers criteria (2012) and STOPP criteria (2008). Methodology: A descriptive, quasi-experimental, before-after study without a control group across the Toledo Primary Care Area (Spain) between January 2014 and April 2015. The inclusion criteria were patients over 65 years of age, taking 7 or more drugs for a period of greater than or equal to 6 months, with an electronic medical record and active drug prescriptions on the Turriano® software platform. We excluded patients with incomplete medical records, patients from other primary-care areas, and hospitalised patients. Patients in palliative or end-of-life care were also excluded from the study. Selection was carried out by simple random sampling. The Beers criteria (2012) and the STOPP criteria (2008) were used to evaluate PIDPs. The main variables were the number of PIs carried out and the number of PIs accepted by the primary-care doctor (PCD). The secondary variables were: demographic variables (age, sex), clinical variables (health issues or diseases), pharmacological variables (number of drugs taken chronically), total number of PIDPs and number of PIDPs per patient, as well as PIDPs identified with the BEERS criteria and the STOPP criteria. The Spearman’s rank test was used to calculate statistical significance, whereby values were considered to be statistically significant if p < 0.05. Results: We included 2,598 patients in the study with a mean age of 79.7 ± 7.5 years; 62.9% were female. The most frequent chronic pathologies were hypertension (83.8%), dyslipidaemia (59.5%), and diabetes (47.7%). The mean number of medications per patient was 10 ± 2.7. The most frequent active substances used (≥ 30% of patients) were omeprazole (61.5%), acetylsalicylic acid (44.6%), paracetamol (33.5%) and simvastatin (32.1%). When applying the Beers criteria, a total of 1,283 PIDP-Beers were identified in 981 patients (37.8%); this gave a mean of 1.31 PIDP-Beers per patient. When applying the STOPP criteria, a total of 2,156 STOPP-PIDPs were identified in 1,148 patients (44.2%); this gave a mean of 1.88 STOPP-PIDPs per patient. There were no significant differences between the number of PIDPs identified by the BEERS criteria and the STOPP criteria (p = 0.464). The highest frequency of PIDP-Beers were central nervous system drugs (19.9%), and for PIDP-STOPP it was drugs that have a negative impact on those with a falls risk (26.2%). PIDPs were more frequent in women, in patients aged 66-69 years, and in patients taking 15 or more drugs, whereby statistically-significant differences were seen (p < 0.001). PIs were performed in 1,409 patients (54.2%). The association between PIs and number of drugs was statistically-significant (p < 0.001). Acceptance of PIs by primary-care doctors was 42.1% and 46.3% respectively for the Beers and STOPP PIDPs. There was no significant difference (p = 0.003) between patients who received a PI and the 3-year mortality rate (26.6% without PI vs. 26.2% with PI). Conclusions: The prevalence of PIDPs in patients over the age of 65 years and who are polymedicated with 7 or more drugs being taken chronically in the Toledo Health Area was high: 37.8% when applying the Beers criteria (2012); and 44.2% when using the STOPP criteria (2008). 42.1% of the pharmacist’s recommendations for PIDPs in application of the Beers criteria were accepted by the primary-care doctor; with 46.3% of PIDP recommendations being accepted under the STOPP criteria. Incorporating a pharmacist into the multidisciplinary team in the field of Primary Care would contribute to optimising pharmacological treatments and the safety of patients who are polymedicated, without requiring additional resources. [ABSTRACT FROM AUTHOR]

Objective: The aims of the present study were: (1) to describe psychotropic drug consumption patterns in palliative care patients with late-stage dementia; (2) to determine the ratio of potentially inappropriate psychotropic agents prescribed to the above population using two different updated criteria for PIPM: 2019 Beers criteria and v2 STOPP criteria. Methods: Cross-sectional, observational study of palliative care patients with late-stage dementia. Data on sociodemographic and clinical variables were collected. Psychotropic drugs were classified into four categories: antipsychotics, antidepressants, benzodiazepines and nonbenzodiazepine sedative-hypnotics. To identify the psychotropic drugs to be avoided, a review of treatments received by the patients was performed based on the 2019 Beers criteria and v2 STOPP criteria. Additionally, the patient's medication list was also examined to identify psychotropic polypharmacy. Results: The study included 107 patients of whom 78.5% were on psychotropic polypharmacy, and 84.1% were prescribed PIPMs according to 2019 Beers criteria and v2 STOPP criteria. Overall, 81.3% of patients were on benzodiazepines, 66.4% on antidepressants, 45.8% on antipsychotics and 37.4% on nonbenzodiazepine sedative-hypnotics. The number of psychotropic medications a person was exposed to range from 1 to 4 with the following prevalence rates: 1 psychotropic drug 21.5%, 2 psychotropic drugs 34.6%, 3 psychotropic drugs 32.7% and 4 psychotropic drugs 11.2%. Conclusions: Optimization of pharmacotherapy has turned into a global public health problem. A significant number of the elderly received PIPMs based on selected criteria. It is crucial to re-evaluate the relevance and efficiency of these medical prescriptions to improve quality of life for these patients. [ABSTRACT FROM AUTHOR]

Objectives: The increase in polypharmacy among older adults increases the risk of drug-related problems, making multidisciplinary interventions essential. This study evaluated the impact of a multidisciplinary polypharmacy consultation on medication management and outcomes in older outpatients., Methods: This prospective observational study at a Spanish teaching hospital involved geriatricians, clinical pharmacists, and nurses. Older adults (≥ 75 years) with polypharmacy underwent medication review at baseline and at 3 and 6 months. Data on medication use, adherence to Screening Tool of Older Person's Prescriptions (STOOP) criteria, and anticholinergic burden were analyzed., Results: The study included 104 older adults (mean age 86.2 years; 66% female). An average of 3.6 recommendations per participant was made (63.8% acceptance rate). Common drug-related problems were adverse effects (20%), non-adherence (18.1%), and incorrect dose/regimen (14.4%). Interventions led to an average reduction of 1.7 medications per patient, with 1.3 dosage or regimen changes and 1.1 new prescriptions. The mean number of medications decreased from 9.6 at baseline to 8.9 at 3 months ( p  < 0.001) and remained below baseline at 6 months. STOPP criteria violations per patient dropped from 1.2 to 1.0 ( p  = 0.036). Of the 126 medications flagged by STOPP criteria, 68.3% were addressed, 24.6% discontinued, mainly psychotropics, and 89.3% of these discontinuations were maintained. The anticholinergic burden decreased from 1.3 to 1.1 at 3 months ( p  = 0.036) and remained below baseline at 6 months., Conclusions: A multidisciplinary clinic effectively managed polypharmacy in older adults by reducing medication load and improving appropriateness per STOPP criteria, highlighting the importance of proactive medication management., Trial Registration: ClinicalTrials.gov: NCT05408598 (March 1, 2022)., Competing Interests: The authors declare no conflicts of interest., (© 2025 The Author(s). Aging Medicine published by Beijing Hospital and John Wiley & Sons Australia, Ltd.)

What is Known and Objectives: Potential inappropriate medications (PIMs) can increase the risk of medication‐induced harm. However, there are no studies regarding PIMs in older and critically ill patients with cardiovascular diseases in China. Therefore, studies evaluating PIMs in these patients can help in the implementation of more effective interventions to reduce the risk of drug use. Our objective was to analyse the prevalence of PIMs in elderly patients admitted to the cardiac intensive care unit (CICU) comparing the 2019 Beers criteria (Beers criteria), Screening Tool of Older People's Potentially Inappropriate Prescriptions (STOPP) criteria version 2 (STOPP criteria) and criteria of potentially inappropriate medications for older adults in China (Chinese criteria); and analyse the factors influencing the PIMs. Methods: This cross‐sectional and retrospective study was performed with elderly patients (≥65 years) admitted to the CICU of the Beijing Tongren Hospital in China from January 2019 to June 2020. The PIMs were identified based on the Chinese, STOPP and Beers criteria at admission and discharge. The three criteria were compared using the Kappa statistic. Multiple regression analysis was used to investigate the influencing factors associated with PIMs. Results and Discussion: A total of 369 patients who met the inclusion/exclusion criteria were included in this study. According to the three criteria used to evaluate the PIMs, the prevalence was 78.3% and 72.6% at admission and discharge, respectively. The prevalence rate of PIMs determined by the Chinese criteria was 62.1% at admission versus 56.6% at discharge (p = 0.134); the Beers criteria was 53.9% at admission versus 46.9% at discharge (p = 0.056); by the STOPP criteria was 20.6% at admission versus 13.8% at discharge (p = 0.015). Moreover, 28.9% (STOPP criteria), 56.8% (Beers criteria) and 73.4% (Chinese criteria) of patients taking PIMs on admission still had the same problem at discharge. The most common PIMs screened by the Beers, STOPP and Chinese criteria were diuretics, benzodiazepines and clopidogrel, respectively. Besides, the three criteria showed poor agreement. Finally, the stronger predictor of PIMs was the increased number of medications (p < 0.05). What is New and Conclusion: The prevalence of PIMs in elderly patients admitted to the CICU was high. The Chinese, STOPP and Beers criteria are effective screening tools to detect PIMs, but the consistency between them was poor. The increased number of medications was a significant predictor of PIMs. [ABSTRACT FROM AUTHOR]

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People above 65 years of age would amount to 10.7% of total population of India by 2021. India has acquired the label of ‘an ageing nation’ with 7.7% of its population being more than 60 years old. Geriatric patients are exposed to potentially inappropriate medications (PIMs) thus strategies to improve quality of life and safety of prescribing is needed. One such explicit criteria tool is ‘Screening Tool of Older person’s Potentially inappropriate Prescriptions’ (STOPP) criteria. For older individuals, frailty plays a decisive role. Frailty assessment is useful for identification of risk stratifications to assist in clinical decision makings. Hence, this study is aimed to assess the percentage of PIM using STOPP criteria and correlation between PIMS and Frailty Index (FI) in elderly patients in our setting. An observational study was done in 60 patients in department of medicine at tertiary care teaching hospital. Demographic details, diagnosis and current medications were recorded in Microsoft excel 2016. PIMs based on STOPP criteria version 2 and FI suggested by Searle et al. was calculated and analyzed. Spearman rank correlation test was used to check the correlation between FI and PIM. Out of 60 prescriptions, 21 prescriptions with PIM were found. Most common drugs prescribed as PIM were Aspirin, calcium, ceftriaxone, multivitamin B complex and furosemide. FI was analyzed by using 34 variables. Value of FI was between 0.03 to 0.17. Spearman Rank correlation test showed direct low degree of significant correlation between FI and PIM with correlation (r) value of 0.1602 (P value=0.02). 35% of prescriptions were having at least one PIM in our study and we found that there was direct association between FI and PIM which will help us to reduce potential medication errors, drug interactions and adverse reactions.

Background: Screening Tool of Older People’s Prescriptions (STOPP) and Screening Tool to Alert to Right Treatment (START) criteria have been used to detect potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs). These criteria were applied to geriatric Portuguese patients receiving post-acute and long-term care to assess the prevalence and predictors of PIMs and PPOs.Methods: An observational, retrospective, cross-sectional and multicenter study was performed in 161 patients (aged ≥65 years) from eight Units for Integrated Continuous Care.Results: In these studied patients (mean age: 81.6, 64% female, median number of medications: 9) PIMs were detected in 85.1% and PPOs in 81.4% of patients. While PIMs mainly involved the central nervous system and psychotropic drugs (66.5%), PPOs were mostly related to musculoskeletal system (55.3%) and cardiovascular (39.8%) system. A subsequent analysis with logistic regression found the female gender, the hospital provenience, and the number of medications as predictors of PIMs. Predictors of PPOs were the Charlson Comorbidity Index and history of recent fractures.Conclusion: PIMs and PPOs were highly prevalent in the studied patients receiving post-acute and long-term care in Units for Integrated Continuous Care. Therefore, STOPP/START criteria might be an effective tool for improving prescribing quality and clinical outcomes in these frail elderly patients.

Background: Screening Tool of Older People's Prescriptions (STOPP) and Screening Tool to Alert to Right Treatment (START) criteria have been used to detect potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs). These criteria were applied to geriatric Portuguese patients receiving post-acute and long-term care to assess the prevalence and predictors of PIMs and PPOs. Methods: An observational, retrospective, cross-sectional and multicenter study was performed in 161 patients (aged ≥65 years) from eight Units for Integrated Continuous Care. Results: In these studied patients (mean age: 81.6, 64% female, median number of medications: 9) PIMs were detected in 85.1% and PPOs in 81.4% of patients. While PIMs mainly involved the central nervous system and psychotropic drugs (66.5%), PPOs were mostly related to musculoskeletal system (55.3%) and cardiovascular (39.8%) system. A subsequent analysis with logistic regression found the female gender, the hospital provenience, and the number of medications as predictors of PIMs. Predictors of PPOs were the Charlson Comorbidity Index and history of recent fractures. Conclusion: PIMs and PPOs were highly prevalent in the studied patients receiving post-acute and long-term care in Units for Integrated Continuous Care. Therefore, STOPP/START criteria might be an effective tool for improving prescribing quality and clinical outcomes in these frail elderly patients. [ABSTRACT FROM AUTHOR]

Aims: To determine the prevalence of potentially inappropriate medication (PIM) use at hospital admission and discharge, and the contribution to hospital admission among residential aged care facility residents with and without dementia. Methods: We conducted a secondary analysis using data from a multihospital prospective cohort study involving consecutively admitted older adults, aged 75 years or older, who were taking 5 or more medications prior to hospital admission and discharged to a residential aged care facility in South Australia. PIM use was identified using the 2015 Screening Tool for Older Persons' Prescription and 2019 Beers criteria. An expert panel of clinicians with geriatric medicine expertise evaluated the contribution of PIM to hospital admission. Results: In total, 181 participants were included, the median age was 87.5 years and 54.7% were female. Ninety‐one (50.3%) had a diagnosis of dementia. Participants with dementia had fewer PIMs, according to at least 1 of the 2 screening criteria, than those without dementia, at admission (dementia: 76 [83.5%] vs no dementia: 84 [93.3%], P =.04) and discharge (78 [85.7%] vs 83 [92.2%], P =.16). PIM use was causal or contributory to the admission in 28.1% of study participants (n = 45) who were taking at least 1 PIM at admission. Conclusions: Over 80% of acutely admitted older adults took PIMs at hospital admission and discharge and for over a quarter of these people the admissions were attributable to PIM use. Hospitalisation presents an opportunity for comprehensive medication reviews, and targeted interventions that enhance such a process could reduce PIM use and related harm. [ABSTRACT FROM AUTHOR]

Drug prescribing to the elderly increases the risk of potential adverse drug reactions as well as potentially inappropriate medications. The goal of this study was to describe drug prescribing patterns in elderly patients and to measure the prevalence of potentially inappropriate medications using updated Beers' criteria and the STOPP criteria. This was a retrospective cross-sectional study for all patients aged ≥65 years who attended regularly a primary care clinic at Sultan Qaboos University Hospital in Oman. Data of 377 patients were analyzed using the software Statistical Package for Social Sciences version 23.0 (SPSS™, Chicago, IL, USA). Using Beers criteria, the prevalence of potentially inappropriate medications was 12.7% as 48 patients had at least one potentially inappropriate medication. Beers criteria revealed a statistical association between the occurrence of potentially inappropriate medications with polypharmacy (p < 0.001), with female gender (p = 0.002) and with asthma as a comorbidity (p = 0.020). STOPP criteria showed that the prevalence of potentially inappropriate medications was 17.2% as 65 patients had at least one potentially inappropriate medication. STOPP criteria revealed a statistical association between the occurrence of potentially inappropriate medications and osteoarthritis as a comorbidity (p = 0.032). The study revealed moderate prevalence of potentially inappropriate medications prescribing in elderly patients which was mainly associated with polypharmacy and female gender. Safe prescribing practices in the elderly requires increasing the awareness of healthcare providers and efficiently reporting drug-related problems. [ABSTRACT FROM AUTHOR]

Purpose: Screening for potentially inappropriate medications (PIM) is recommended in older patients with cancer receiving chemotherapy, given the concern for adverse drug reactions, drug-drug interactions and non-adherence. Our objective was to determine the impact of PIM on outcomes in patients with breast and colorectal cancers receiving chemotherapy. Methods: We used data from the SEER-Medicare database, including patients >/= 66 years old with a diagnosis of Stage II/III breast and colorectal cancer made between 7/1/2007–12/31/2009. We used modified STOPP criteria to define baseline PIM as a dichotomous variable in the 4 months prior to diagnosis. STOPP criteria was used based on its performance as a robust measure of PIM. Outcomes measures included ER visits, hospitalizations, and death within 3 months from the last chemotherapy, and a composite of the three. We used Chi-square or Fisher's exact test to determine associations of PIM with covariates and outcomes, and Cox proportional hazards (PH) model for the time-to-event analysis. Results: Final analysis included 1,595 patients with breast cancer and 1,528 patients with colorectal cancer. Frequency of baseline PIM by STOPP was 31.5% in the breast and 30.9% in the colorectal cohort. In the breast cohort, associations with the composite outcome in the Cox PH model included disease stage, comorbidity, medication number and baseline ER visits/hospitalization. Age, gender, race, comorbidity and baseline ER visits/hospitalization were associated in the colorectal cohort. PIM was not associated with outcomes in either cohort, aside from hospitalization in the breast. We found no consistent association between pre-chemotherapy PIM defined by STOPP and outcomes. [ABSTRACT FROM AUTHOR]

Objective: To assess potentially inappropriate prescribing (PIP) using Beers (2012 version) and STOPP (2008 version) criteria in polypharmacy, community-dwelling, older patients. Methods: From the information collected in the invoicing data of the prescriptions and the electronic medical records, a sample was selected of 223 ≥ 65-year-old patients who were taking simultaneously 10 or more drugs per day. Beers and STOPP criteria were separately applied, and the results obtained with the two methods were compared. Results: A total of 141 (63.2%) patients presented at least one Beers criterion. The two most frequently observed Beers criteria independent of diagnosis were the use of benzodiazepines and the use of non-COX-2-selective non-steroidal anti-inflammatory drugs. With regard to Beers criteria considering diagnosis, the most frequent were the use of anticholinergic drugs in patients with lower urinary tract symptoms or benign prostatic hyperplasia, and the use of benzodiazepines, antipsychotics, zolpidem or H2-antihistamines, in patients with dementia or cognitive impairment. A total of 165 (73.9%) patients had at least one PIP according to the STOPP criteria. Duplicate drug classes and long-term use of long-acting benzodiazepines were the two most frequent STOPP criteria. Discussion: Our study identified a high frequency of PIP in polymedicated community-dwelling older patients. Simultaneous application of Beers and STOPP criteria represents a useful tool to improve prescribing in this population group.

Objectives: This study aimed to compare the prevalence of potentially inappropriate medications (PIMs) among Chinese aged patients using the Beers criteria of 2015, the Screening Tool of Older Persons’ Prescriptions (STOPP) of 2014 and the criteria of PIMs for older adults in China (Chinese criteria), and to identify the correlates of the PIMs’ use. Methods: A retrospective, cross-sectional study was conducted among geriatric patients at Beijing Chao-Yang Hospital between January 2018 and March 2018. Three criteria (the Beers criteria of 2015, the STOPP criteria of 2014 and the Chinese criteria) were used to detect PIMs. A multivariate logistic regression analysis was carried out to determine factors associated with the use of PIMs. Leading PIMs for each set of criteria were also listed. The concordance among the three PIM criteria was calculated using kappa tests. Results: Totally, 863 inpatients aged ≥65 years were included. The prevalence of patients receiving at least one PIM was 80.2%, 58.1% and 44.0% according to the Chinese criteria, 2015 Beers criteria and 2014 STOPP criteria, respectively. The Beers and the STOPP criteria indicated a moderate coherence, whereas the Chinese criteria showed poor concordance with the other two criteria. Proton-pump inhibitors in the Beers and STOPP criteria and clopidogrel in the PIM-Chinese accounted for most leading PIMs. The most important factor associated with PIM use by all three sets of criteria was the number of prescribed medications. Conclusion: Data showed a high PIM prevalence among older adults in China, which was associated with the number of prescribed medications. The Chinese criteria had the highest detection rate but a poor concordance with the Beers and STOPP criteria (P<0.001). [ABSTRACT FROM AUTHOR]

Objective To assess and compare, according to Beers and STOPP criteria, the frequency and causes of potentially inappropriate medications (PIMs) in elderly, as well as the relationship between PIMs use and patient’s treatment satisfaction, evaluated using the Treatment Satisfaction Questionnaire for Medications (TSQM). Method 350 patients (mean age = 73.49 years), taking a total of 1893 medications, were enrolled from community pharmacies. Results 6.2% and 20.4% of the medications were inappropriate according to the STOPP and Beers lists respectively; 103 (29.4%) and 210 (60%) patients had at least one PIM according to STOPP and Beers criteria respectively. The most common cause of PIM was a full dose of proton pomp inhibitor for >8 weeks (STOPP) and using a drug that exacerbates/causes syndrome of inappropriate antidiuretic hormone secretion (Beers). The number of medications taken by the participant, advanced age, female gender, prescription of medications for anxiety/depression, ulcers/gastroesophageal reflux, rheumatoid arthritis and epilepsy significantly increased the PIMs number. When using STOPP criteria, all TSQM subscale scores were significantly lower among patients with PIM use compared to those without PIM. The same trend was observed for Beers critertia, with a significant difference reached for side effects and convenience subscales only. Conclusion Selecting the appropriate tools to assess PIMs, prescribers and patient education regarding the risks associated with PIMs, and patient’s perception and satisfaction regarding his treatment, are critical issues to be addressed among older adults. [ABSTRACT FROM AUTHOR]

ABSTRACT Purpose Despite well-established concerns regarding adverse drug effects, antipsychotics are frequently prescribed for older adults. Our first objective was to identify trends in antipsychotic dispensations to older Nova Scotians. STOPP (Screening Tool of Older Persons' Potentially Inappropriate Prescriptions) criteria identify antipsychotic use in those with a history of falls as potentially inappropriate. Our second objective was to identify trends, predictors, and adherence with this STOPP criteria by identifying continued antipsychotic dispensations following a fall-related hospitalization. Methods A descriptive cross-sectional cohort study of Nova Scotia Seniors' Pharmacare Program (NSSPP) beneficiaries ≥ 66 years with at least one antipsychotic dispensation annually from April 1, 2009 to March 31, 2014 was completed. As well, unique beneficiaries with at least one antipsychotic dispensation in the four-year period between April 1, 2009 and March 31, 2013 were linked to fall-related hospitalizations recorded in the Canadian Institute for Health Information Discharge Abstract Database. The relationship of age, sex, fiscal year, days supply and length-of-stay were studied to identify predictors of continued antipsychotic dispensation post-discharge. Descriptive statistics and multivariate logistic analysis were performed. Odds ratios for the association of risk factors and adherence to STOPP criteria were calculated. Findings We identified that in each year observed, there were 6% of eligible NSSPP beneficiaries that received at least one antipsychotic dispensation. Approximately 70% of antipsychotic dispensations were for second generation agents, primarily quetiapine and risperidone. Of the unique beneficiaries with at least one antipsychotic dispensation in the four-year period between April 1, 2009 and March 31, 2013 who survived a fall-related hospitalization over 75% were dispensed an antipsychotic in the 100 days following hospital discharge. Logistic regression showed no statistically significant association between potentially inappropriate therapy and potential predictors in multivariate analysis. Implications In each year from 2009 to 2014, 6% of Nova Scotia Seniors' Pharmacare beneficiaries were dispensed at least one antipsychotic prescription. Over 75% of the older adults who received an antipsychotic dispensation in the 100 days prior to a fall-related hospitalization, continued the drug class after discharge. This demonstrates that despite the recommendations of quality indicators such as the STOPP criteria, antipsychotics are continued in individuals at a high risk of falling. Future investigations are needed to inform health team, system, and policy interventions to improve concordance with this antipsychotic specific STOPP criterion when appropriate. [ABSTRACT FROM AUTHOR]

Background and Objectives: The purpose of the study was to determine the prevalence rate of potentially inappropriate prescribing (PIP), by using the Screening Tool of Older Person’s potentially inappropriate Prescriptions (STOPP) criteria in older outpatients, and its association with potential clinically significant drug−drug interactions (csDDIs). Materials and Methods: A cross-sectional study included 248 outpatients ≥65 years old divided into two groups depending on the presence of csDDIs. For estimating the clinical significance of csDDIs we used Medscape′s "Drug Interaction Checker". We applied the thirty PIP indicators from the STOPP criteria. Results: The presence of PIP (25.00%; all patients) was significantly higher in the group with potential csDDIs compared to the other group (43 vs. 19, respectively; Chi-square test, χ2 = 9.947; p < 0.01). The most common PIP included the inappropriate use of proton pump inhibitors, long acting benzodiazepines, usage of thiazide diuretic in patients with gout, and duplication of therapeutic class. Patients with potential csDDIs had 43 potentially inappropriate medications (PIMs) prescribed. Out of this number, 12 (27.91%) PIMs were identified to participate in potential csDDIs. There was a correlation between the number of medications prescribed and the number of PIMs (ρ = 0.297; p < 0.01) and between the number of PIPs and the number of potential csDDIs (ρ = 0.170; p < 0.01). Conclusions: Older outpatients with potential csDDIs in relation to those with no potential csDDIs had significantly more prescribed drugs in total as well as inappropriate drugs. Almost 30% of these PIMs were included in potential csDDIs.

Background: There is a difference between evidence-based guidelines for geriatric patients and clinical practice of physicians. Prescribing potentially inappropriate medications (PIMs) can be attributed to the fact that many physicians are not aware of PIMs usage. Aim: The aim of this study was to assess the effectiveness of a combined intervention program comprising an educational and clinical pharmacist intervention to reduce the incidence of PIMs among hospitalized geriatric patients. Methods: This was a prospective pre-test versus post-test design study. The screening tool of older persons' prescriptions, 2nd version, and 2015 American Geriatric Society Beers' criteria were used to assess the appropriateness of medications prescribed for geriatric inpatients. The study was carried out in the medical wards of the Department of Medicine at King Abdulaziz Medical City in Riyadh, Saudi Arabia. Results: Four hundred geriatric patients were enrolled in the study: 200 in a pre-intervention group (control) and 200 in the intervention group. After the combined intervention, the incidence rate of PIMs decreased significantly from 61% to 29.5% (p<0.001). Out of 317 recommendations given by the clinical pharmacist, the physicians accepted a total of 196 (61.83%) recommendations. The most common PIMs to avoid regardless of diagnosis of geriatric patients before interventions were first-generation antihistamines (46%), sliding scale insulin (18.5%), antipsychotics (6.5%), benzodiazepines (9.5%), and antiarrhythmic drugs (15%). Conclusion: Using a combined intervention program that comprises an educational intervention of updated evidence-based guidelines and clinical pharmacist intervention would add a significant value to improve prescribing patterns in hospitalized geriatric patients. [ABSTRACT FROM AUTHOR]

Background STOPP (Screening Tool of Older Person’s Prescriptions) criteria have been used in acute care and nursing home settings as a screening tool to assess Potentially Inappropriate Medication (PIM) for elderly people. Furthermore, this tool could help General Practitioners (GPs) to lower PIM frequency in primary care. Objective The aim of the study was to measure the impact of STOPP criteria applied by the GP on prescriptions during a primary care consultation. Setting, subjects and method Twenty GPs were involved and trained to use STOPP criteria. GPs were asked to use STOPP criteria for elderly patients (>75 years old) who were taking at least five different drugs, seen over a two-month period. The rate of PIM according to STOPP criteria was measured before and after training. Prescription quality was compared using the Medication Appropriateness Index (MAI) score. Results Overall, 172 prescriptions were analyzed. A total of 170 PIM were identified according to STOPP criteria before the intervention. Fifty-seven percent of the population (n = 98 patients) had at least one PIM. GP’s intervention decreased the number of PIM according to STOPP criteria to 106 and was beneficial for 44.9% of the patients (n = 44). The mean MAI score of all medications and PIM decreased by 14.3% (p < 0.001) and 39.1% (p < 0.001) respectively. Discussion conclusions Application of STOPP criteria by GPs is an effective tool to decrease PIM and MAI score in primary care. The generalization of the use of STOPP criteria during GP consultation should be fostered. [ABSTRACT FROM AUTHOR]

Purpose: To compare the prevalence and type of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) on admission and discharge of patients, and to determine the associated predictors. Methods: This was a prospective observational study conducted in the multidisciplinary medical and surgical units of Hospital Tengku Ampuan Afzan (HTAA), Malaysia. The medications of patients who had been admitted to the hospital from community-dwelling settings were reviewed to identify PIMs/PPOs using version 2 of STOPP/START criteria. A logistic regression model was applied to detect the risk factors associated with PIM or PPO at discharge. Results: Among the 300 patients involved in the study, the prevalence of PIMs was 27 % upon admission, which decreased to 22.3 % at discharge (p = 0.014) with PIMs pertaining to increasing the risk of physical falls in elderly people being the most common for pre- and post-hospitalization. The prevalence of PPOs was 47.6 % upon admission, which increased to 48 % at discharge (p = 0.99), with the omission of musculoskeletal medications being the most common PPOs at admission and discharge. Having a PIM at discharge was associated with the number of discharge medications and the history of falls, whereas having a high comorbidity index score or history of falls was associated with having a PPO at discharge. Conclusion: Hospitalization significantly reduces the prevalence of PIMs, but not PPOs or polypharmacy, among elderly patients. The number of discharge medications and the history of falls are predictors of discharge PIM, whilst high comorbidities and the history of falls were the predictors of discharge PPO. Improving the knowledge of hospital practitioners regarding geriatric pharmacotherapy is required to optimize prescribing in elderly patients during hospitalization. [ABSTRACT FROM AUTHOR]

Background Potentially inappropriate medications (PIMs) are common in older patients with polypharmacy, and are related to negative clinical results. Little information is available on the characteristics and consequences of PIMs in patients with advanced chronic conditions and palliative care needs. Objective To evaluate, for this population: (i) the prevalence of PIMs; (ii) the possible risk factors associated with its onset; and (iii) the related clinical consequences. Setting Acute-hospital care Geriatric Unit (AGU) in County of Osona, Spain. Method Ten-month prospective cross-sectional study. Patients with palliative care needs were identified according to the NECPAL CCOMS-ICO® test. Upon hospital admission, a multidisciplinary team consisting of a pharmacist and two AGU physicians determined the PIMs of the routine chronic medication of the patients. Sociodemographic and pharmacological data were collected with the objective of determining possible risk factors related to the existence of PIMs. Main outcome measure Prevalence and type of PIMs according to STOPP version 2 and MAI criteria at the time of hospital admission. Furthermore, days of hospital admission, destination at hospital discharge and survival analysis at 12 months related to PIMs were evaluated. Results Two hundred thirty-five patients (mean age 86.80, SD 5.37; 65.50% women) were recruited. According to the STOPP criteria, 88.50% of patients had ≥1 criterion (mainly 'indication of medication', followed by those that affect the nervous system and psychotropic drugs and risk drugs in people suffering from falls), and according to the MAI tool, 97.40% of the patients had some criterion related to inappropriate medication (mainly, duration of therapy). The following conditions were identified as risk factors for the existence of PIMs: insomnia, anxiety-depressive disorder, falls, pain, excessive polypharmacy and therapeutic complexity. There were no differences among patients in days of hospital stay, discharge's destination or survival at 12 months, regardless of the tool used. Conclusion The presence of PIMs is high in patients requiring palliative care. Some potentially modifiable risk factors such as the pharmacological ones are associated with a greater presence of inappropriate medication. The presence of PIMs does not affect this population in terms of mortality. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate the clinical relevance of potentially inappropriate medications (PIMs), identified by the STOPP criteria, and potential prescribing omissions (PPOs), identified by the START criteria, and to identify predictors for clinically relevant PIMs and PPOs. Methods: The STOPP and START criteria were applied on the medication lists of 200 older hip fracture patients, consecutively recruited to a randomized controlled study in 2009. For each identified PIM and/or PPO, the clinical relevance was assessed at the individual level, using medical records from both hospital and primary care as well as data collected in the original study. Results: A total of 555 PIMs/PPOs were identified in 170 (85%) patients (median age: 85 years, 67% female), 298 (54%) of which, in 141 (71%) patients, were assessed as clinically relevant. A greater proportion of PIMs than PPOs were clinically relevant: 71% (95% CI: 66%; 76%) vs. 32% (27%; 38%). A greater proportion of PPOs than PIMs could not be assessed with available information: 38% (32%; 44%) vs. 22% (17%; 27%). Number of drugs and multidose drug dispensing, but not age, sex, cognition, or nursing home residence, were associated with ≥1 clinically relevant PIMs/PPOs. Conclusions: The present study illustrates that one in two PIMs/PPOs identified by the STOPP/START criteria is clearly clinically relevant, PIMs being clinically relevant to a greater extent than PPOs. Based on available information, the clinical relevance could not be determined in a non-negligible proportion of PIMs/PPOs. Number of drugs and multidose drug dispensing were associated with ≥1 clinically relevant PIMs/PPOs. [ABSTRACT FROM AUTHOR]

Objectives To compare 24-month outcomes of participants of a prospective randomized controlled trial ( RCT) assigned to undergo a medication intervention of orally communicated recommendations based on Screening Tool of Older Persons potentially inappropriate Prescriptions ( STOPP) and Screening Tool to Alert Doctors to Right Treatment ( START) (intervention group) with outcomes of those assigned to undergo written medication review (control group). Design Retrospective cohort study. Setting Chronic care geriatric facility. Participants Of 359 participants from a prospective RCT conducted between April 2012 and September 2013, 306 were evaluable for another 12-month follow-up. Measurements Outcomes at 24-month follow-up included quality of prescribing (assessed according to STOPP/ START), hospitalizations, falls, costs of medications, and all-cause mortality. Outcomes were compared with those reported at the beginning (baseline) and end (12-month follow-up) of the RCT. Results There was a significant rise in potentially inappropriate prescriptions ( PIPs) ( P = .01) and potentially prescriptions omissions ( PPOs) ( P < .001) in the intervention group between 12 and 24 months, although the prevalence of PIPs was significantly lower in the intervention group (33.3%) than the control group (48.4%) at 24-month follow-up ( P = .02). Costs of medications were significantly lower in the intervention group than the control group ( P < .001) at 24-month follow-up. The average number of falls in both groups dropped significantly between baseline and study closure ( P = .04 and P = .008, respectively). There was no significant difference in hospitalizations and mortality between the two groups at 24-month follow-up. Conclusion The effect of an orally communicated medication intervention with the STOPP/ START criteria on falls was maintained over time. Direct communication between pharmacists and prescribing physicians is more efficient than written medication review and is recommended every 6 months in geriatric facilities. [ABSTRACT FROM AUTHOR]

Objectives The aim of this study was to assess the prevalence of potentially inappropriate medication (PIM) use upon admission and at discharge in a geriatric oncology unit after involving a clinical pharmacist. Although the few studies conducted in geriatric oncology units used the 2003 Beers criteria, this study used START and STOPP criteria, a more appropriate tool for European formularies. Materials and Methods Prospective study in older (≥ 70 years) patients consecutively admitted to a geriatric oncology unit in a cancer center from July 2011 to April 2012. Clinical pharmacist conducted a complete comprehensive medication review including non-prescription and complementary (herbals) medications. This information coupled with the patient's medical history allows identifying PIMs using the STOPP and START criteria. The number of PIMs at admission and at discharge from the hospital was compared after clinical pharmacist intervention. Results Ninety-one older patients with cancer (mean age ± SD = 79 ± 6 years) were included in the study. START criteria identified 41 PIMs for 31 persons (34%) at admission compared to 7 PIMs for 6 persons (7%) at discharge. STOPP criteria identified 50 PIMs at admission for 29 persons (32%) compared to 16 PIMs at discharge for 14 persons (16%). Results showed significantly lower START scores at discharge than at admission (p < 0.001); similarly, STOPP criteria demonstrated fewer PIMs at discharge than at admission (p < 0.001). Conclusion The use of START and STOPP criteria by a clinical pharmacist allows identifying PIMs and changing prescriptions for older patients with cancer in agreement with the oncologist and geriatrician of the team. [ABSTRACT FROM AUTHOR]

Unlabelled: Background Potentially inappropriate medications (PIMs) are often found in high proportion among the elderly population. The STOPP criteria have been suggested to detect more PIMs in European elderly than the Beers criteria. Objective This study aimed to determine the prevalence of PIMs and potential prescribing omissions (PPOs) in a sample of Portuguese nursing homes residents. Setting Four elderly facilities in mainland Portugal Method A descriptive cross-sectional study was used. Elderly polypharmacy patients were included in the study and their medication (registered in patient clinical records) analysed using the Beers (2012 original version and 2008 version adapted to Portugal), STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment) criteria. Data were analysed using univariate and bivariate descriptive statistics, considering a confidence interval of 95 %.Main Outcome Measures: Prevalence of PIMs and PPOs. Results The sample included 161 individuals, with a mean age of 84.7 years (SD = 6.35), 68.9 % being female. A total of 807 PIMs and 90 PPOs were identified through the application of the three set of criteria. The prevalence of PIMs using the most recent version of the Beers criteria was 85.1 and 42.1 % for independent and dependent of diagnosis, respectively. The Portuguese adaptation of this same tool indicated a lower prevalence of PIMs, 60.3 and 16.7 %, respectively. The prevalence of PIMs using the STOPP criteria was 75.4 %, whilst the prevalence of PPOs, using START, was 42.9 %. There were significant differences in the mean number of PIMs detected depending on the tool used. (p < 0.001). Conclusions The application of the studied criteria in an elderly sample enabled the identification of a notable amount of PIMs and PPOs, indicating there is room for improving the quality of care. The variation in prevalence indicates careful choice of the tool is a prerequisite for engaging in medication review. Using START/STOPP criteria enabled a more holistic approach to the quality of prescribing in the elderly, highlighting low levels of cardiovascular risk prevention and abuse of psychotropic drugs, aside with system failures largely preventable by electronic prescribing and alert generation. [ABSTRACT FROM AUTHOR]

BACKGROUND: The optimization of medication use during care transitions represents an opportunity to improve overall health-related outcomes. The utilization of clinical pharmacists during care transitions has demonstrated benefit, although the optimal method of integration during the care transition process remains unclear. OBJECTIVE: To evaluate the impact of pharmacist-provided telephonic medication therapy management (MTM) on care quality in a care transitions program (CTP) for high-risk older adults. METHODS: This prospective, randomized, controlled study was conducted from December 8, 2011, through October 25, 2012, in a primary care work group at a tertiary care academic medical center in the midwestern United States. High-risk elderly (aged ≥60 years) patients were randomized to a pharmacist-provided MTM program via telephone or to usual care within an existing outpatient CTP. The primary outcome was the quality of medication prescribing and utilization based on the Screening Tool to Alert Doctors to the Right Treatment (START) and the Screening Tool of Older Persons' Prescriptions (STOPP) scores. The secondary outcomes were medication utilization using a modified version of the Medication Appropriateness Index, hospital resource utilization within 30 days of discharge, and drug therapy problems. RESULTS: Of 222 eligible high-risk patients, 25 were included in the study and were randomized to the pharmacist MTM intervention (N = 13) or to usual care (N = 12). No significant differences were found between the 2 groups in medications meeting the STOPP or START criteria. At 30-day follow-up, no significant differences were found between the 2 cohorts in medication utilization quality indicators or in hospital utilization. At 30-day follow-up, 3 (13.6%) patients had an emergency department visit or a hospital readmission since discharge. In all, 22 patients completed the study. Medication underuse was common, with 20 START criteria absent medications evident for all 25 patients at baseline, representing 15 (60%) patients with ≥1 missing medications. Overall, 55 drug therapy problems were identified at baseline, 24 (43.6%) of which remained unresolved at 30-day follow-up. CONCLUSION: The use of a pharmacist-provided MTM program did not achieve a significant difference compared with usual care in an existing CTP; however, the findings demonstrated frequent utilization of inappropriate medications as well as medication underuse, and many drug therapy problems remained unresolved. The small size of the study may have limited the ability to detect a difference between the intervention and usual care groups. [ABSTRACT FROM AUTHOR]

To describe dispensing patterns of antipsychotic medications to long-term care (LTC) residents and assess factors associated with continuation of an antipsychotic after a fall-related hospitalization. A retrospective cohort study. Nova Scotia Seniors Pharmacare Program (NSSPP) beneficiaries age 66 years and older who resided in LTC and received at least 1 dispensation of an antipsychotic within the study period of April 1, 2009, to March 31, 2017. Linkage of administrative claims data from the NSSPP and the Canadian Institute of Health Information Discharge Abstract Database identified LTC residents with an antipsychotic dispensation and from the subgroup of those dispensed antipsychotic medications who experienced a fall-related hospitalization. Antipsychotic dispensing patterns were reported with counts and means. Predictors of continuation of an antipsychotic after a fall-related hospitalization (sex, length of stay, days supplied, age, year of admission, rural/urban) were reported and analyzed with multiple logistic regression. There were 19,164 unique NSSPP beneficiaries who were dispensed at least 1 prescription for an antipsychotic medication. Of those who received at least 1 antipsychotic dispensation 90% (n = 17,201) resided in LTC. A mean of 40% (n = 2637) of LTC residents received at least 1 antipsychotic dispensation in each year. Risperidone and quetiapine were dispensed most frequently. Of the 544 beneficiaries residing in LTC who survived a fall-related hospitalization, 439 (80.7%) continued an antipsychotic after hospital discharge. Female sex [OR 1.7, 95% CI (1.013‒2.943)], age 66‒69 [OR 4.587, 95% CI (1.4‒20.8)], 75-79 [OR 2.8, 95% CI (1.3‒6.3)], and 80‒84 years [OR 3.1, 95% CI (1.6‒6.4)] (compared with age 90+ years) were associated with increased risk of antipsychotic continuation. With 90% of antipsychotic dispensations in Nova Scotia being to LTC residents and 40% of LTC residents being dispensed antipsychotics in any year there is a need to address this level of antipsychotic dispensation to older adults. [ABSTRACT FROM AUTHOR]

Objectives To compare the predictive validity of the 2003 Beers, 2012 American Geriatrics Society ( AGS) Beers, and Screening Tool of Older Persons' potentially inappropriate Prescriptions ( STOPP) criteria. Design Retrospective cohort. Setting Managed care administrative claims data from 2006 to 2009. Participants Commercially insured persons aged 65 and older in the United States (N = 174,275). Measurements Association between adverse drug events ( ADEs), emergency department ( ED) visits, and hospitalization outcomes and inappropriate medication use using time-varying Cox proportional hazard models. Measures of model discrimination (c-index) and hazard ratios ( HRs) were calculated to compare unadjusted and adjusted models for associations. Results The prevalence of inappropriate prescribing was 34.1% for the 2012 AGS Beers criteria, 32.2% for the 2003 Beers criteria, and 27.6% for the STOPP criteria. Each set of criteria modestly discriminated ADEs in unadjusted analyses ( STOPP criteria: hazard ratio ( HR) = 2.89, 95% confidence interval ( CI) = 2.68-3.12, C-index = 0.607; 2012 AGS Beers criteria: HR = 2.51, 95% CI = 2.33-2.70, C-index = 0.603; 2003 Beers criteria: HR = 2.65, 95% CI = 2.46-2.85, C-index = 0.605). Similar results were observed for ED visits and hospitalizations. The c-indices increased to between 0.65 and 0.70 in adjusted analyses. The kappa for agreement between criteria was 0.80 for the 2003 and 2012 AGS Beers criteria, 0.58 for the 2012 AGS Beers and STOPP criteria, and 0.59 for the 2003 Beers and STOPP criteria. For the three outcomes, the 2012 AGS Beers criteria had the highest sensitivity (61.2-71.2%) and the lowest specificity (41.2-70.7%), and the STOPP criteria had the lowest sensitivity (53.8-64.7%) but the highest specificity (47.8-78.1%). Conclusion All three criteria were modestly prognostic for ADEs, EDs, and hospitalizations, with the STOPP criteria slightly outperforming both Beers criteria. With low sensitivity, low specificity, and low agreement between the criteria, they can be used in a complementary fashion to enhance sensitivity in detecting ADEs. [ABSTRACT FROM AUTHOR]

The article presents a study which discusses the incidence of potentially inappropriate medications (PIMs) among elderly patients in Nigeria. The researchers used Beers and Screening Tool of Older Persons' Potentially Inappropriate Prescription (STOPP) criteria to define prescribed medications inappropriateness. Results revealed the need for medication prescribers in the country to undergone continuing education in prescribing drugs to elderly patients to reduce the high prevalence of PIM.

Potentially inappropriate medications impact pharmacotherapy for the older adult in critical care settings. Critical care teams must be aware of the Beers and Screening Tool of Older Person's Prescriptions criteria as resources to identify medications that may cause adverse drug events in the elderly. Although criteria should not replace clinical judgment, awareness of these guidelines may direct critical care teams to minimize dosing and duration of potentially inappropriate medications to improve outcomes in the intensive care unit. [ABSTRACT FROM AUTHOR]

Background Screening Tool of Older Person's Prescriptions (STOPP) and the Screening Tool to Alert doctors to Right Treatment (START) have been increasingly used to evaluate potentially inappropriate prescriptions (PIPs) and potentially prescription omissions (PPOs). The impact of hospitalization on PIPs/PPOs has not been investigated in depth. Objective To compare the prevalence of PIPs/PPOs in elderly patients on hospital admission and discharge and to identify associated risk factors. Setting An acute medical geriatric division of the Tel Aviv Medical Center (Israel). Method This retrospective cross-sectional study included patients admitted from 12/2011 to 12/2012 aged ≥65 years. Data from patients' records included demographic details, diagnoses and medications at admission and discharge. STOPP/START criteria were applied to each patient's record. Main outcome measure Prevalence of PIPs/PPOs on hospital admission and discharge. Results Three hundred patients were included (mean ± SD age 81.9 ± 7.2 years). Admission PIPs prevalence was 39.3 % (118 patients, 172 PIPs) and it increased to 46.0 % (138 patients, 209 PIPs) at discharge ( P = 0.009). Admission PPOs prevalence was 41.0 % (123 patients, 153 PPOs) and it decreased to 28.3 % (85 patients, 99 PPOs) at discharge ( P < 0.001). Having at least one PIP/PPO at discharge but not at admission was associated with length of hospital stay (OR 1.02, 95 % CI 1.001-1.03). History of falls increased the risk of being a 'new PIP patient' (OR 2.25, 95 % CI 1.03-4.9), whereas diabetes increased the risk of being a 'new PPO patient' (OR 3.86, 95 % CI 1.2-12.5). Conclusion Hospitalization in a geriatric division resulted in an increase in PIPs and a decrease in PPOs. Strategies to reduce PIPs need to be implemented, especially for patients with longer hospital stay and a history of falls. [ABSTRACT FROM AUTHOR]

Objectives The Beers (2012) criteria and the screening tool of older persons' potentially inappropriate prescriptions (STOPP) criteria are often used to identify potentially inappropriate medication (PIM) use in elderly patients. The aim of this study is to determine the prevalence of PIM use in nursing home residents (NHRs) aged ≥65 years presenting to the Emergency Department (ED); to compare the Beers and STOPP criteria and to identify the potential role of PIMs in ED attendances. Setting The ED of an urban tertiary referral hospital. Participants Acutely unwell long-term care NHRs seeking medical assistance at the ED. Design and Measurements This is a retrospective cohort study. Demographic and clinical data were retrieved from the ED electronic record system, from the clinical records, and transfer letters for all NHRs who attended the ED in 2011. Beers 2012 and STOPP criteria were used to identify PIMs. Results Of 195 NHRs identified, 165 were included. The mean age (±standard deviation) was 82.5 (±7.7) years; 110 (66.7%) were female and 157 (95.2%) were prescribed at least 1 PIM by either criterion. One hundred forty patients (84.8%) received a PIM according to STOPP criteria and 147 (89.1%) according to the Beers criteria. In the majority of patients (148; 89.7%), there was a difference in the medications Beers and STOPP identified as inappropriate. Fifty patients (30.3%) were considered to have a link between their attendance at ED and the PIM prescribed when assessed subjectively. Objective assessment using the WHO-UMC criteria found 7 (4.2%) had a ‘probable’ link and 45 (27.3%) a ‘possible’ link. Conclusions These results show a high rate of PIM prescribing in this cohort. The use of criteria such as Beers and STOPP may be a useful guide for physicians coordinating the long-term care of NHRs and may have the potential to reduce attendances at ED. [ABSTRACT FROM AUTHOR]

Objectives To assess the effect of a Screening Tool of Older Persons potentially inappropriate Prescriptions/Screening Tool to Alert doctors to Right Treatment ( STOPP/ START) medication intervention on clinical and economic outcomes. Design Parallel-group randomized trial. Setting Chronic care geriatric facility. Participants Residents aged 65 and older prescribed with at least one medication (N = 359) were randomized to receive usual pharmaceutical care or undergo medication intervention. Intervention Screening medications with STOPP/ START criteria followed up with recommendations to the chief physician. Measurements The outcome measures assessed at the initiation of the intervention and 1 year later were number of hospitalizations and falls, Functional Independence Measure ( FIM), quality of life (measured using the Medical Outcomes Study 12-item Short-Form Health Survey), and costs of medications. Results The average number of drugs prescribed was significantly lower in the intervention than in the control group after 1 year ( P < .001). The average drug costs in the intervention group decreased by 103 shekels (US$29) per participant per month ( P < .001). The average number of falls in the intervention group dropped significantly ( P = .006). Rates of hospitalization, FIM scores, and quality of life measurements were similar for both groups. Conclusion Implementation of STOPP/ START criteria reduced the number of medications, falls, and costs in a geriatric facility. Their incorporation in those and similar settings is recommended. [ABSTRACT FROM AUTHOR]