Inappropriate prescribing in hospitalised Australian elderly as determined by the STOPP criteria
- 1k Downloads
Background The elderly population is increasing worldwide. Due to age-related physiological changes that affect the pharmacokinetics and pharmacodynamics of drugs, the elderly are predisposed to adverse drug reactions. Prescribing of potentially inappropriate medications (PIMs) has been found to be prevalent among the elderly and PIM use has been associated with hospitalisations and mortality. Objectives This study aims to identify the prevalence and nature of pre-admission inappropriate prescribing by using the STOPP (screening tool of older people’s prescriptions) criteria amongst a sample of hospitalised elderly inpatients in South Australia. Setting Medical, surgical and rehabilitation wards of a public teaching hospital in Adelaide, South Australia. Main outcome measure Pre-admission prevalence of PIM. Method Medication management plans of 100 patients of ≥65 years old were prospectively studied to determine the prevalence of pre-admission PIM use. Sixty-five criteria of STOPP were applied to identify PIMs. Results The total number of pre-admission medications screened during the study period was 949; the median number of medicines per patient was nine (range 2–28). Overall the STOPP criteria identified 138 PIMs in 60 % of patients. The most frequently encountered PIM was opiates prescribed in patients with recurrent falls (12.3 %), followed by benzodiazepines in fallers (10.1 %) and proton pump inhibitors when prescribed for peptic ulcer disease for long-term at maximum doses (9.4 %). The number of medications were found to have a positive correlation with pre-admission PIM use (rs = 0.49, P < 0.01). Conclusions Pre-admission PIM use is highly prevalent among the studied population. Strategies to reduce PIM use should be undertaken by physicians and pharmacists. The use of the STOPP criteria in clinical practice to reduce prescriptions of inappropriate medications requires further investigation.
KeywordsAustralia Elderly Potentially inappropriate prescribing (PIP) Potentially inappropriate medicines (PIM) Screening tool of older person’s prescriptions (STOPP)
Conflicts of interest
No conflicts of interest to declare.
- 1.Department of Economic and Social Affairs, Population Division. World population ageing, 1950–2050. New York: United Nations; 2002. http://www.un.org/esa/population/publications/worldageing19502050/. Accessed 6 June 2012.
- 2.Australian Bureau of Statistics. Population by age and sex, Australian States and territories, June 2010. Belconnen, ACT: Australian Bureau of Statistics; 2010. http://www.abs.gov.au/Ausstats/abs@.nsf/mf/3201.0. Accessed 5 June 2012.
- 6.Liu GG, Christensen DB. The continuing challenge of inappropriate prescribing in the elderly: an update of the evidence. J Am Pharm Assoc (Wash). 2002;42(6):847–57.Google Scholar
- 7.Pattanaworasate W, Emmerton L, Pulver L, Winckel K. Comparison of prescribing criteria in hospitalised Australian elderly. Pharmacy Pract (Internet). 2010;8(2):132–8.Google Scholar
- 8.Widagdo IS, Nyfort-Hansen K, Kowalski SR. Prevalence of potentially inappropriate medication use in elderly hospitalised patients. J Pharm Prac Res. 2011;41(2):122–5.Google Scholar
- 24.Gallagher P, Baeyens JP, Topinkova E, Madlova P, Cherubini A, Gasperini B. Inter-rater reliability of STOPP (Screening Tool of Older Persons’ Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment) criteria amongst physicians in six European countries. Age Ageing. 2009;38(5):603–606.Google Scholar
- 25.Rossi S. Australian medicines handbook. Adelaide: Australian Medicines Handbook Pty Ltd; 2009. (ISBN 978–097-5791–99-8).Google Scholar
- 37.Australian Prescriber. Top 10 drugs. Deakin, ACT: Australian Prescriber; 2010. http://www.australianprescriber.com/magazine/33/6/artid/1149. Accessed 6 June 2012.