Predictive Validity of the Beers and Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions (STOPP) Criteria to Detect Adverse Drug Events, Hospitalizations, and Emergency Department Visits in the United States

Abstract

OBJECTIVES To compare the predictive validity of the 2003 Beers, 2012 Beers, and STOPP Criteria. DESIGN Retrospective cohort. SETTING Managed care administrative claims data from 2006 to 2009 PARTICIPANTS 174,275 commercially insured persons 65 and older in the United States. MEASUREMENTS Association between adverse drug events, emergency department (ED) visits, and hospitalization outcomes and inappropriate medications using time-varying Cox proportional hazard models. Measures of model discrimination (c-index) and hazard ratios (HR) were calculated to compare unadjusted and adjusted models for associations. RESULTS The prevalence of inappropriate prescribing was 34.1%, 32.2%, and 27.6% for the 2012 Beers, 2003 Beers, and the STOPP Criteria. Each criteria modestly discriminated ADEs in unadjusted analyses: STOPP Criteria (HR=2.89 [2.68–3.12]; C-index=0.607), 2012 Beers Criteria (HR=2.51 [2.33–2.70]; C-index=0.603), 2003 Beers Criteria (HR=2.65 [2.46–2.85]; C-index=0.605). Similar results were observed for ED visits and hospitalizations. Adjusted analyses increased the c-indices to between 0.65 and 0.70. The kappa for agreement between criteria was 0.80 for the 2003 and 2012 Beers Criteria, 0.58 for the 2012 Beers and STOPP Criteria, and 0.59 for the 2003 Beers and STOPP Criteria. For the three outcomes, the 2012 Beers Criteria had the highest sensitivity (61.2%–71.2%) and the lowest specificity (41.2%–70.7%) while the STOPP Criteria had the lowest sensitivity (53.8%–64.7%) but the highest specificity (47.8%–78.1%). CONCLUSIONS 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, as well as low agreement between the criteria, these criteria can be used in a complementary fashion to enhance sensitivity of detecting ADEs.

Prevalence, predictors and clinical impact of potentially inappropriate prescriptions in hospital‐discharged older patients: A prospective study

“…7,[9][10][11][12][13][14]17,19 However, it is not possible to discern whether these findings reflect a real increase of the prevalence of inappropriate prescriptions or rather a higher sensibility and lower specificity of Beers Criteria 2015, which have not been compared with previous lists yet. 7,[9][10][11][12][13][14]17,19 However, it is not possible to discern whether these findings reflect a real increase of the prevalence of inappropriate prescriptions or rather a higher sensibility and lower specificity of Beers Criteria 2015, which have not been compared with previous lists yet.…”

“…[8][9][10][11][12][13][14][15][17][18][19]21 According to previous studies, the most frequent disease-or syndrome-related inappropriate drugs were anticholinergics, H 2 -receptor antagonists, benzodiazepines and antipsychotics in patients with dementia, and anticonvulsants, antipsychotics, benzodiazepines, old and new antidepressants, and opioids in patients with history of falls or fractures. [8][9][10][11][12][13][14][15][17][18][19]21 According to previous studies, the most frequent disease-or syndrome-related inappropriate drugs were anticholinergics, H 2 -receptor antagonists, benzodiazepines and antipsychotics in patients with dementia, and anticonvulsants, antipsychotics, benzodiazepines, old and new antidepressants, and opioids in patients with history of falls or fractures.…”

“…Several studies showed a high prevalence of PIP among older adults, which has been associated with polypharmacy, 3,4 advanced age, 3,5 comorbidity 3,4 and female sex. 1 PIP, according to previous versions (2003 and 2012) of the Beers Criteria, have been investigated, mainly in retrospective studies, in hospital patients, [7][8][9][10][11][12][13][14][15][16] long-term care facilities residents 17,18 and community-dwelling older adults, [19][20][21] with high variance of prevalence of PIP between and within different clinical settings. The Beers Criteria were first published in 1991, 6 and periodically updated until the last version endorsed in 2015.…”

Application of STOPP/START and Beers criteria: Compared analysis on identification and relevance of potentially inappropriate prescriptions

“…Since their first iteration in 2008, STOPP/ START criteria have demonstrated their interest, not only to improve PIM detection compared to Beers, but also of their significant association with ADEs, unlike Beers 2003 criteria medication [7]. More recently, the predictive validity of the 2003 Beers, 2012 American Geriatric Society (AGS) Beers, and STOPP criteria were compared in 174,275 insured people aged 65 and older; and STOPP criteria outperformed both Beers criteria to prevent ADEs, hospitalizations, and emergency department visit in the United States [44].…”

Beers Criteria versus Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions in evaluation of drug-prescribing practice in an Indian hospital

“…Among hospitalised patients, ADR PIM is assumed when the adverse effect outweighs the clinical outcome and a more effective and safer therapy is available for the same problem. [3][4][5] There are various criteria to identify PIM in elderly patients. 6 Although the Beers Criteria are commonly used in large-scale epidemiological studies, some of the Beers Criteria are controversial and almost half of PIMs in the Beers Criteria are unavailable in European formularies.…”