1. Drugs Aging. 2012 Oct;29(10):829-37. doi: 10.1007/s40266-012-0016-1.

Inappropriate prescribing and related hospital admissions in frail older persons 
according to the STOPP and START criteria.

Dalleur O, Spinewine A, Henrard S, Losseau C, Speybroeck N, Boland B.

Pharmacy Department, Cliniques universitaires Saint-Luc, Université catholique de
Louvain, Brussels, Belgium. olivia.dalleur@uclouvain.be

BACKGROUND: Over the last few years, the Screening Tool of Older Person's
Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment
(START) criteria have been increasingly used to evaluate the prevalence of
inappropriate prescribing. However, very few studies have evaluated the link
between these criteria and clinical outcomes.
OBJECTIVES: The objectives of this study were to evaluate the prevalence of
inappropriate prescribing according to STOPP and START in a population of frail
elderly persons admitted acutely to hospital; to evaluate whether these
inappropriate prescribing events contributed to hospital admissions; and to
identify determinants of hospital admissions potentially related to inappropriate
prescribing.
METHODS: This was a cross-sectional study including all frail older patients
admitted to a 975-bed teaching hospital over a 12-month period. A pharmacist and 
a geriatrician independently detected events of prescribing of potentially
inappropriate medication (PIM) and potential prescribing omission (PPO), using
the STOPP and START criteria, respectively, in all patients included in the
study. They determined whether the inappropriate prescribing event was the main
cause or a contributory cause of hospital admission. Demographic, clinical and
geriatric clinical syndromes (i.e. cognitive impairment, falls) were evaluated as
potential determinants of hospital admissions related to inappropriate
prescribing, using multivariate methods (i.e. logistic regression and a
classification tree).
RESULTS: 302 frail older persons (median age 84 years) were included in the
study. PIMs (prevalence 48%) mainly involved overuse and/or misuse of
benzodiazepines, aspirin and opiates. PPOs (prevalence 63%) were mainly related
to underuse of calcium and vitamin D supplementation, aspirin and statins.
Overall, inappropriate prescribing according to STOPP (54 PIMs) and/or START (38 
PPOs) led or contributed to hospital admission in 82 persons (27%). The
multivariate analyses indicated a relation between PIM-related admissions and a
history of previous falls (p < 0.001), while the PPO-related admissions were
associated with a history of osteoporotic fracture (p < 0.001) and atrial
fibrillation (p = 0.004).
CONCLUSIONS: Using the STOPP and START criteria, it was found that inappropriate 
prescribing events (both PIMs and PPOs) were frequent and were associated with a 
substantial number of acute hospital admissions in frail older persons.
Fall-induced osteoporotic fracture was the most important cause of hospital
admission related to inappropriate prescribing and should be a priority for
pharmacological optimization approaches.

PMID: 23044639  [PubMed - in process]