Potentially inappropriate prescribing in institutionalised older patients in Spain: the STOPP-START criteria compared with the Beers criteria

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Abstract

Objective: The aims of this study were to identify potentially inappropriate prescribing using the Beers and STOPP criteria. The START criteria were applied to detect prescription omission in the geriatric population. We compared the utility of these criteria in institutionalised older people. Methods: Descriptive study reviewing the medication and clinical records of 81 residents (aged 65 years and more) by pharmacists in a nursing home in the Lleida region (Spain). Results: The mean patients´ age was 84 (SD=8) years, with an average of 5 drugs per resident (total prescriptions: 416 medicines). The Beers criteria identified potentially inappropriate medication use in 25% of patients and 48% of patients used at least 1 inappropriate medication according to STOPP criteria. The most frequent potentially inappropriate medications for both criteria were long-acting benzodiazepines and NSAIDs. START detected 58 potential prescribing omissions in 44% of patients. Calcium-vitamin D supplementation in osteoporosis was the most frequent rule (15%), but omissions corresponding to the cardiovascular system implied 23% of patients. Conclusion: The STOPP-START criteria reveal that potentially inappropriate prescribing (PIP) is a highly prevalent problem among Spanish nursing home residents, and a statistically significant positive correlation was found between the number of medicines prescribed and the number of PIP detected in this study. The STOPP criteria detect a larger number of PI medications in this geriatric population than the Beers criteria. The prescribing omissions detected by the START criteria are relevant and require intervention. Pharmacists´ review of medications may help identify potentially inappropriate prescribing and, through an interdisciplinary approach, working with physicians may improve prescribing practices among geriatric residents of nursing homes.

Translated abstract

Objetivo: Este estudio está orientado a identificar la prescripción potencialmente inapropiada usando los criterios de Beers y STOPP. Las omisiones de prescripciones se detectan en esta población geriátrica aplicando los criterios START. Se compara la utilidad de estos criterios en ancianos institucionalizados. Métodos: Estudio descriptivo de revisión de la medicación y las historias clínicas por farmacéuticos, de 81 pacientes (con 65 o más años) ingresados en una residencia en la provincia de Lleida (España). Resultados: La media de edad de los pacientes fue de 84 años (DE=8), con cinco medicamentos de promedio de tratamiento por residente (prescripciones totales: 416 medicamentos). Los criterios de Beers detectaron el uso de medicación potencialmente inapropiada en el 25% de los pacientes. Los criterios STOPP identificaron una posible medicación inapropiada en el 48% de los pacientes. La mayor frecuencia de uso de medicamentos potencialmente inapropiados para ambos criterios correspondió a las benzodiacepinas de larga duración y los AINE. Los criterios START detectaron 58 prescripciones potencialmente omitidas en el 44% de los pacientes. Entre ellas, la ausencia de suplementos de Calcio-vitamina D en osteoporosis fue la regla más frecuentemente implicada (15% de los pacientes); sin embargo, las omisiones relacionadas con el sistema cardiovascular asociadas a elevado riesgo cardiovascular son las que implicaron hasta un 23% de pacientes. Conclusión: La aplicación de los criterios STOPP-START ha detectado una elevada proporción de prescripciones potencialmente inapropiadas en pacientes ancianos en una residencia sanitaria en España, con una significativa correlación positiva entre el número de medicamentos prescritos al paciente y el número de prescripciones potencialmente inapropiadas. Los criterios STOPP identificaron más medicación potencialmente inapropiada que los criterios de Beers. Las omisiones detectadas por los criterios START son relevantes y requiere una intervención. La revisión de la medicación por un farmacéutico puede ayudar a identificar potenciales prescripciones inapropiadas y, con un abordaje interdisciplinario, en colaboración con los médicos se podría mejorar la prescripción en pacientes ancianos de residencias geriátricas.

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Most cited references 54

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Polypharmacy in elderly patients.

Emily R Hajjar, Angela C. Cafiero, Joseph T Hanlon (2007)

Polypharmacy (ie, the use of multiple medications and/or the administration of more medications than are clinically indicated, representing unnecessary drug use) is common among the elderly. The goal of this research was to provide a description of observational studies examining the epidemiology of polypharmacy and to review randomized controlled studies that have been published in the past 2 decades designed to reduce polypharmacy in older adults. Materials for this review were gathered from a search of the MEDLINE database (1986-June 2007) and International Pharmaceutical Abstracts (1986-June 2007) to identify articles in people aged >65 years. We used a combination of the following search terms: polypharmacy, multiple medications, polymedicine, elderly, geriatric, and aged. A manual search of the reference lists from identified articles and the authors' article files, book chapters, and recent reviews was conducted to identify additional articles. From these, the authors identified those studies that measured polypharmacy. The literature review found that polypharmacy continues to increase and is a known risk factor for important morbidity and mortality. There are few rigorously designed intervention studies that have been shown to reduce unnecessary polypharmacy in older adults. The literature review identified 5 articles, which are included here. All studies showed an improvement in polypharmacy. Many studies have found that various numbers of medications are associated with negative health outcomes, but more research is needed to further delineate the consequences associated with unnecessary drug use in elderly patients. Health care professionals should be aware of the risks and fully evaluate all medications at each patient visit to prevent polypharmacy from occurring.

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Exposure to potentially inappropriate drugs and drug-drug interactions in elderly nursing home residents in Helsinki, Finland: a cross-sectional study.

Helka Hosia-Randell, S Muurinen, Kaisu H Pitkälä (2007)

Multiple drug use is common among old, frail nursing home residents who are, as a consequence, susceptible to adverse effects and drug interactions. This study uses the updated Beers criteria for potentially inappropriate drug (PID) use in older adults to determine the extent and nature of PIDs in older nursing home residents in Helsinki, Finland. The study also uses the Swedish, Finnish, INteraction X-referencing (SFINX) interaction database to assess the possibility of clinically significant class D ("clinically significant interaction, and the combination should be avoided") drug-drug interactions (DDIs) in the same population. This study is a cross-sectional assessment of all nursing home residents aged > or = 65 years in Helsinki. The residents' demographic information and medical data were collected from medical charts in February 2003. Of all nursing home residents in Helsinki, 82% (n = 1987) were eligible for analysis. Their mean age was 83.7 (SD 7.7) years, 80.7% were female and 69.5% were diagnosed with dementia. The mean number of drugs given on a regular basis per resident was 7.9 (SD 3.6) per day. Of the study population, 34.9% regularly used at least one PID. Residents taking PIDs were more likely to be taking psychotropic medication and to be taking nine or more drugs daily, and less likely to have a diagnosis of dementia, than patients not taking PIDs. The three most prevalent PIDs were: (i) short-acting benzodiazepines in greater than recommended doses (13.9% of all residents), of which temazepam >15 mg/day was the most commonly used agent and, indeed, the most common PID (taken by 13.5% of all residents); (ii) hydroxyzine (7.1%); and (iii) nitrofurantoin (6.3%). Together, these three PIDs accounted for 76.9% of all PID use. Of all residents, 4.8% were susceptible to a clinically significant DDI. The most common potential DDIs were related to the use of potassium-sparing diuretics, carbamazepine and codeine. Compared with residents not exposed to potential DDIs, residents exposed to potential DDIs were more likely to be younger, to have a prior history of stroke, to be taking psychotropics, to be taking nine or more drugs daily and to be taking PIDs. Use of PIDs is very common among nursing home residents, and this increases the likelihood of DDIs. Monitoring patients for PID use and potential drug interactions could increase the quality of prescribing.

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Revalidation and standardization of the cognition mini‐exam (first Spanish version of the mini‐mental status examination) in the general geriatric population

A LOBO, P Saz, G MARCOS … (1999)

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Author and article information

Contributors

Amalia Ubeda: Role: ND

M. Luisa Ferrándiz: Role: ND

Nuria Maicas: Role: ND

Cristina Gomez: Role: ND

Montserrat Bonet: Role: ND

Jose E. Peris: Role: ND

Journal

Journal ID (publisher): pharmacin

Title: Pharmacy Practice (Internet)

Abbreviated Title: Pharmacy Practice (Internet)

Publisher: Centro de Investigaciones y Publicaciones Farmacéuticas (Redondela )

ISSN: 1886-3655

Publication date (Print): June 2012

Volume: 10

Issue: 2

Pages: 83-91

Affiliations

[1 ] Universitat de València Spain

[2 ] Community Pharmacy Spain

[3 ] General Practitioner South Africa

[4 ] Universitat de València Spain

Article

Publisher ID: S1886-36552012000200004

DOI: 10.4321/s1886-36552012000200004

SO-VID: befedebf-9eb9-4d90-b3ea-2ae13c8c26cb

License:

http://creativecommons.org/licenses/by/4.0/

History

Product

SciELO Spain

Self URI (journal page): http://scielo.isciii.es/scielo.php?script=sci_serial&pid=1886-3655&lng=en

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