Factors associated to potentially inappropriate prescribing in older patients according to STOPP/START criteria: MoPIM multicentre cohort study
Open Access
- 11 January 2022
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Geriatrics
- Vol. 22 (1), 1-12
- https://doi.org/10.1186/s12877-021-02715-8
Abstract
The objectives of the present analyses are to estimate the frequency of potentially inappropriate prescribing (PIP) at admission according to STOPP/START criteria version 2 in older patients hospitalised due to chronic disease exacerbation as well as to identify risk factors associated to the most frequent active principles as potentially inappropriate medications (PIMs). A multicentre, prospective cohort study including older patients (≥65) hospitalized due to chronic disease exacerbation at the internal medicine or geriatric services of 5 hospitals in Spain between September 2016 and December 2018 was conducted. Demographic and clinical data was collected, and a medication review process using STOPP/START criteria version 2 was performed, considering both PIMs and potential prescribing omissions (PPOs). Primary outcome was defined as the presence of any most frequent principles as PIMs, and secondary outcomes were the frequency of any PIM and PPO. Descriptive and bivariate analyses were conducted on all outcomes and multilevel logistic regression analysis, stratified by participating centre, was performed on the primary outcome. A total of 740 patients were included (mean age 84.1, 53.2% females), 93.8% of them presenting polypharmacy, with a median of 10 chronic prescriptions. Among all, 603 (81.5%) patients presented at least one PIP, 542 (73.2%) any PIM and 263 (35.5%) any PPO. Drugs prescribed without an evidence-based clinical indication were the most frequent PIM (33.8% of patients); vitamin D supplement in older people who are housebound or experiencing falls or with osteopenia was the most frequent PPO (10.3%). The most frequent active principles as PIMs were proton pump inhibitors (PPIs) and benzodiazepines (BZDs), present in 345 (46.6%) patients. This outcome was found significantly associated with age, polypharmacy and essential tremor in an explanatory model with 71% AUC. PIMs at admission are highly prevalent in these patients, especially those involving PPIs or BZDs, which affected almost half of the patients. Therefore, these drugs may be considered as the starting point for medication review and deprescription. NCT02830425This publication has 56 references indexed in Scilit:
- Potentially inappropriate prescribing according to the STOPP/START criteria for older adultsAging Clinical and Experimental Research, 2015
- STOPP/START criteria for potentially inappropriate prescribing in older people: version 2Age and Ageing, 2014
- Pharmacotherapy of Essential TremorJournal of Central Nervous System Disease, 2013
- Potentially inappropriate prescribing in older residents in Irish nursing homesAge and Ageing, 2012
- Potentially Inappropriate Medications Defined by STOPP Criteria and the Risk of Adverse Drug Events in Older Hospitalized PatientsJAMA Internal Medicine, 2011
- Updating and Validating the Charlson Comorbidity Index and Score for Risk Adjustment in Hospital Discharge Abstracts Using Data From 6 CountriesAmerican Journal of Epidemiology, 2011
- 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 countriesAge and Ageing, 2009
- STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions): application to acutely ill elderly patients and comparison with Beers' criteriaAge and Ageing, 2008
- START (screening tool to alert doctors to the right treatment) an evidence-based screening tool to detect prescribing omissions in elderly patientsAge and Ageing, 2007
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987