Assessing Potentially Inappropriate Prescribing in Community-Dwelling Older Patients Using the Updated Version of STOPP-START Criteria: A Comparison of Profiles and Prevalences with Respect to the Original Version

Abstract

Emerging and changing evidence made it necessary to update STOPP-START criteria, and version 2 was published recently. In this study the objectives were to determine the prevalence of potentially inappropriate medication prescribing (PIM) in primary care using STOPP versions 1 (v1) and 2 (v2), as well as 2012 AGS Beers criteria, and analyze the factors associated with inappropriate prescribing according to STOPP/START v2. A cross-sectional study was carried out including community-dwelling older adults over the age of 65. Sociodemographic, clinical, functional and comprehensive drug therapy data were collected. The primary endpoint was the percentage of patients receiving at least one PIM. This variable was measured using three tools: STOPP v1, 2012 AGS Beers criteria and STOPP v2. Similarly, the percentage of patients receiving at least one potential prescribing omission (PPO) was calculated using START versions 1 and 2. A total of 1,615 prescriptions were reviewed. The median number of medications per patient was 7.1 drugs (±3.8). The prevalence of elderly people exposed to polypharmacy (≥5 medications) was 72.9%, whereas 28.4% of the participants took ≥10 drugs regularly. PIM were present in 18.7%, 37.3% and 40.4% of participants, according to the STOPP v1, 2012 Beers criteria and STOPP v2, respectively. According to STOPP v2, the number of medications taken (OR: 1.14, 1.06–1.25), the presence of a psychological disorder (OR: 2.22, 1.13–4.37) and insomnia (OR: 3.35, 1.80–6.32) were risk factors for taking a PIM. The prevalence of PPOs was 34.7% and 21.8% according to version 1 and 2, respectively. In conclusion, STOPP-START criteria have been remarkably modified, which is evidenced by the different prevalence rates detected using version 2, as compared to version 1. In fact, the level of agreement between version 1 and the updated version is only moderate. Special attention should be paid on benzodiazepines, which keep being the most frequent PIM.

Potentially Inappropriate Prescribing in Older Adults with Hypertension or Diabetes Mellitus and Hypertension in a Primary Care Setting in Bahrain

“…In our study which included older adults with hypertension or diabetes and hypertension, often with other morbidities, the mean number of medications/patient prescribed for chronic (long-term) and acute (short-term) medical conditions appears to be comparable to that reported in Turkey [17] but less than that reported from Spain [18, 19] in studies on patients in the similar age group and care setting but without specifying the nature of chronic diseases.…”

“…Its use either alone or as a fixed-dose combination is best avoided because it can increase the risk of cognitive impairment, delirium, impaired balance, falls, and fractures [8, 25]. Long-acting benzodiazepine (chlordiazepoxide), identified as the fourth common PIP in our study, was the most common PIP reported in several European Union countries [2, 18, 20-22, 24]. …”

“…The current observational study revealed that the mean prevalence of ≥PIP was estimated to be 34.1%; only 27.7% (18 out of 65) of STOPP criteria were applicable. Of note, authors of other recent studies who recruited patients in a similar age group, care-setting, and STOPP criteria reported a prevalence that ranged from 14.8 to 52.7% [2, 17, 18, 20-24]. The disparity in the prevalence rates could be attributed to variables such as the study design, the physician’s prescribing behavior, the nature of the chronic morbidity, prescribing regulations, and the clinical setting [12, 18, 24].…”

“…Of note, authors of other recent studies who recruited patients in a similar age group, care-setting, and STOPP criteria reported a prevalence that ranged from 14.8 to 52.7% [2, 17, 18, 20-24]. The disparity in the prevalence rates could be attributed to variables such as the study design, the physician’s prescribing behavior, the nature of the chronic morbidity, prescribing regulations, and the clinical setting [12, 18, 24]. Furthermore, the primary care essential drug list, the regional drug market situation, and country-specific PIP are other determinants of PIP prevalence and PIP subsets that can be identified using STOPP criteria.…”

“…This is because orphenadrine has strong anticholinergic properties and increases the risk of sedation, confusion, falls, and fractures [8, 25]. None of the published primary care-based studies [2, 17, 18, 20-24] have identified PIP of orphenadrine. In contrast, orphenadrine was the most common PIP detected in our study.…”