Factors associated to potentially inappropriate prescribing in older patients according to STOPP/START criteria: MoPIM multicentre cohort study

Abstract

Objectives The objectives of the present analyses are to estimate the frequency of potentially inappropriate prescribing (PIP) at admission according to STOPP/START criteria version 2 in older patients hospitalised due to chronic disease exacerbation as well as to identify risk factors associated to the most frequent active principles as potentially inappropriate medications (PIMs). Methods A multicentre, prospective cohort study including older patients (≥65) hospitalized due to chronic disease exacerbation at the internal medicine or geriatric services of 5 hospitals in Spain between September 2016 and December 2018 was conducted. Demographic and clinical data was collected, and a medication review process using STOPP/START criteria version 2 was performed, considering both PIMs and potential prescribing omissions (PPOs). Primary outcome was defined as the presence of any most frequent principles as PIMs, and secondary outcomes were the frequency of any PIM and PPO. Descriptive and bivariate analyses were conducted on all outcomes and multilevel logistic regression analysis, stratified by participating centre, was performed on the primary outcome. Results A total of 740 patients were included (mean age 84.1, 53.2% females), 93.8% of them presenting polypharmacy, with a median of 10 chronic prescriptions. Among all, 603 (81.5%) patients presented at least one PIP, 542 (73.2%) any PIM and 263 (35.5%) any PPO. Drugs prescribed without an evidence-based clinical indication were the most frequent PIM (33.8% of patients); vitamin D supplement in older people who are housebound or experiencing falls or with osteopenia was the most frequent PPO (10.3%). The most frequent active principles as PIMs were proton pump inhibitors (PPIs) and benzodiazepines (BZDs), present in 345 (46.6%) patients. This outcome was found significantly associated with age, polypharmacy and essential tremor in an explanatory model with 71% AUC. Conclusions PIMs at admission are highly prevalent in these patients, especially those involving PPIs or BZDs, which affected almost half of the patients. Therefore, these drugs may be considered as the starting point for medication review and deprescription. Trial registration number NCT02830425

Potentially Inappropriate Medication and Polypharmacy in Nursing Home Residents: A Cross-Sectional Study

“…In the present study, 61.5% of NH residents had one or more medications omitted from their treatments according to the START criteria, which is much higher than those reported by other authors at 19.8-57.7% [29,36,37]. Some reasons that may explain this high rate of drug omissions are the need to avoid polypharmacy in an overtreated population, the clinical experience of the physician in charge, and also the existence of comorbidities, which may discourage one from adding more medicine.…”

“…Inappropriate polypharmacy is a global problem in the elderly, as it decreases their quality of life and increases medication costs and healthcare system use. In the present study, the prevalence of PIM was 96.3% (v2 STOPP criteria) and 90.8% (2019 Beers criteria), which is much higher than the range reported elsewhere (9.7-79.3%) [29,[32][33][34][35][36][37][38]. PIMs should be carefully reviewed for discontinuation, especially when there is evidence of a more effective or safer alternative drug, as it is related to a higher risk of triggering adverse events [13].…”

“…Unnecessary drugs were also a significant predictor to take into account in the detection of PIMs according to the STOPP criteria. In this sense, it should be noted that the highest number of PIMs detected (55.8%) was in criteria A1 (any drug prescribed without an evidence-based clinical indication), which is more than double the value reported by Baré et al (25.7%) [29]. A1 is a very diverse criterion, and it does not specify which drug is involved in the pharmacological groups.…”

“…Nevertheless, detection with the PRISCUS list was higher in the hospital (41.9%) [31]. Other authors have reported a prevalence of 9.7-73.2% for version 2 STOPP criteria [29,[32][33][34][35][36][37] and 68.8-79.3% for 2019 Beers criteria [33,38].…”

“…Table 6 shows the prevalence rates for PIM and the sensitivity and specificity of the 2019 Beers criteria and PRISCUS list in comparison to the v2 STOPP criteria. These latter criteria were used as the reference standard because they are the most currently used and validated in European elderly population [29]. In this sense, the European Union Geriatric Medicine Society (EUGMS) has supported these criteria since 2011 [30].…”