2015 Beers Criteria and STOPP v2 for detecting potentially inappropriate medication in community-dwelling older people: prevalence, profile, and risk factors
To comparatively assess the prevalence rates of potentially inappropriate medications (PIMs) obtained by the former and latest versions of American Geriatrics Society Beers Criteria (AGS BC) and screening tool of older person’s potentially inappropriate prescriptions (STOPP), and analyze the factors of influence on PIM.
Cross-sectional study including 582 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.
A total of 3626 prescriptions were analyzed. PIMs were detected in 35.4% and 47.9% of patients according to the STOPP v1 and the 2012 AGS BC, respectively. This percentage rose to 54% when 2015 AGS BC were used and reached 66.8% with STOPP v2. The kappa coefficient between STOPP v2 and its former version was lower than the one between the updated Beers Criteria and their former version (0.41 vs 0.85). The agreement was good (0.65) between both latest criteria. The number of medications, psychological disorders, and insomnia were predictors of PIM. A novel finding was that bone and joint disorders increased the odds for PIM by 78%.
The 2015 AGS BC showed high sensitivity and good applicability to the European older patients. Both updated tools identified some pharmacological groups (benzodiazepines, PPIs, and opioids, among others) and certain health problems (insomnia, psychological disorders, and osteoarticular diseases) as factors of influence on PIM. Based on these findings, interventions aimed at promoting appropriate use of medications should be developed.
KeywordsPotentially inappropriate medications STOPP version 2 Beers Criteria Older adults
The authors wish to thank the Primary Care Management Team (Health District of Málaga) for providing access to the health centers and patient lists.
Study concept and design: EBR, GAZ. Data collection: JV, LAC, MRGM. Data analysis: EBR, ROR. Interpretation: EBR, GAZ, IBE, ROR, JV, LAC, MRGM. Drafting of the manuscript: EBR, IBE. Revision and final approval: EBR, JV, LAC, MRGM, ROR, IBE, GAZ. Funding acquisition: EBR.
This research has been supported by grant funding provided by the Fundación Pública Andaluza Progreso y Salud, Consejería de Salud, Junta de Andalucía, through the Programme Proyectos de Investigación Biomédica (Grant number PI 0234/14).
Compliance with ethical standards
The study has been approved by the Clinical Research Ethics Committee of Málaga and is being conducted in accordance with the 1964 Helsinki declaration and its later amendments. Written informed consent was obtained from all individual participants prior to their inclusion.
Conflict of interest
All authors declare that they have no conflict of interest.
- 11.Gallagher P, Lang PO, Cherubini A, Topinková E, Cruz-Jentoft A, Montero Errasquín B, Mádlová P, Gasperini B, Baeyens H, Baeyens JP, Michel JP, O’Mahony D (2011) Prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals. Eur J Clin Pharmacol 67(11):1175–1188CrossRefGoogle Scholar
- 19.Novaes PH, da Cruz DT, Lucchetti ALG, Leite ICG, Lucchetti G (2017) Comparison of four criteria for potentially inappropriate medications in Brazilian community-dwelling older adults. Geriatr Gerontol Int 17(10):1628–1635Google Scholar
- 24.Muhlack DC, Hoppe LK, Stock C, Haefeli WE, Brenner H, Schöttker B (2018) The associations of geriatric syndromes and other patient characteristics with the current and future use of potentially inappropriate medications in a large cohort study. Eur J Clin Pharmacol 74(12):1633–1644CrossRefGoogle Scholar
- 25.Blanco-Reina E, Ariza-Zafra G, Ocaña-Riola R, León-Ortiz M (2014) 2012 American Geriatrics Society Beers Criteria: enhanced applicability for detecting potentially inappropriate medications in European older adults? A comparison with the screening tool of older person’s potentially inappropriate prescriptions. J Am Geriatr Soc 62(7):1217–1223CrossRefGoogle Scholar
- 34.Santos AP, da Silva DT, dos Santos Júnior GA, Silvestre CC, Nunes MA, Lyra DP Jr, Antoniolli AR (2015) Evaluation of the heterogeneity of studies estimating the association between risk factors and the use of potentially inappropriate drug therapy for the elderly: a systematic review with meta-analysis. Eur J Clin Pharmacol 71(9):1037–1050CrossRefGoogle Scholar
- 36.Bruin-Huisman L, Abu-Hanna A, van Weert HCPM, Beers E (2017) Potentially inappropriate prescribing to older patients in primary care in the Netherlands: a retrospective longitudinal study. Age Ageing 46(4):614–619Google Scholar
- 38.Brown JD, Hutchison LC, Li C, Painter JT, Martin BC (2016) 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. J Am Geriatr Soc 64(1):22–30CrossRefGoogle Scholar
- 39.Mucalo I, Hadžiabdić MO, Brajković A, Lukić S, Marić P, Marinović I, Bačić-Vrca V (2017) Potentially inappropriate medicines in elderly hospitalised patients according to the EU(7)-PIM list, STOPP version 2 criteria and comprehensive protocol. Eur J Clin Pharmacol 73(8):991–999CrossRefGoogle Scholar
- 50.Tan ECK, Sluggett JK, Johnell K, Onder G, Elseviers M, Morin L, Vetrano DL, Wastesson JW, Fastbom J, Taipale H, Tanskanen A, Bell JS, (Optimizing Geriatric Pharmacotherapy through Pharmacoepidemiology Network –OPPEN- Group) (2018) Research priorities for optimizing geriatric pharmacotherapy: an international consensus. J Am Med Dir Assoc 19(3):193–199CrossRefGoogle Scholar