Potentially Inappropriate Medications Defined by STOPP Criteria and the Risk of Adverse Drug Events in Older Hospitalized Patients

Study Questions:

What is the effect of the new STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions) criteria on adverse drug events (ADEs) in older people with acute illness?

Methods:

The investigators prospectively studied 600 consecutive patients 65 years or older who were admitted with acute illness to a university teaching hospital over a 4-month interval. Potentially inappropriate medicines were defined by both Beers and STOPP criteria. Adverse drug events were defined by World Health Organization–Uppsala Monitoring Centre criteria and verified by a local expert consensus panel, which also assessed whether ADEs were causal or contributory to current hospitalization. Hallas criteria defined ADE avoidability. The authors compared the proportions of patients taking Beers criteria potentially inappropriate medicines (PIMs), and STOPP criteria PIMs with avoidable ADEs that were causal or contributory to admission.

Results:

A total of 329 ADEs were detected in 158 of 600 patients (26.3%); 219 of 329 ADEs (66.6%) were considered causal or contributory to admission. Of the 219 ADEs, 151 (68.9%) considered causal or contributory to admission were avoidable or potentially avoidable. After adjusting for age, sex, comorbidity, dementia, baseline activities of daily living function, and number of medications, the likelihood of a serious avoidable ADE increased significantly when STOPP PIMs were prescribed (odds ratio, 1.847; 95% confidence interval [CI], 1.506-2.264; p < 0.001); prescription of Beers criteria PIMs did not significantly increase ADE risk (odds ratio, 1.276; 95% confidence interval, 0.945-1.722; p = 0.11).

Conclusions:

The authors concluded that STOPP criteria PIMs, unlike Beers criteria PIMs, are significantly associated with avoidable ADEs in older people.

Perspective:

The present study results indicate that STOPP criteria are more sensitive to PIMs that result in ADEs than Beers criteria and are, therefore, more clinically relevant. The direct clinical benefit of using STOPP criteria as a tool to prevent ADEs in older people was not studied. However, given the data showing that routine application of STOPP criteria significantly improves medication appropriateness compared with standard pharmaceutical care, it is reasonable to assume that STOPP as an intervention tool might also attenuate ADE incidence in older people. A randomized controlled trial is needed to address this question and whether routine application of STOPP and START (Screening Tool to Alert doctors to Right Treatment) criteria leads to significant reductions in medication costs and health care utilization costs.

Clinical Topics: Sleep Apnea

Keywords: Incidence, Dementia, Drug-Related Side Effects and Adverse Reactions, Pharmaceutical Services, Inappropriate Prescribing, Universities, Hospitalization


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