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Researchers Evaluate Criteria To Detect Potentially Inappropriate Medications In Older Hospitalized Patients

anti-depressant medicationUsing the Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions (STOPP) criteria was associated with identification of adverse drug events in older patients, according to a report in the June issue of Archives of Internal Medicine, one of the JAMA/Archives journals. The article is part of the journal’s Less Is More series.

According to information in the article, adverse drug events (ADEs) are a significant issue in the older population, and are thought to represent an important cause of hospitalization and account for substantial health care expenditures. Some ADEs are associated with potentially inappropriate medications (PIMs): agents that may cause problems in older patients “because of the higher risk of intolerance related to adverse pharmacodynamics or pharmacokinetics or drug-disease interactions.”

During the last two decades, the Beers criteria for judging whether a medication is appropriate for use in an older patient have become the leading standard. Nevertheless, the authors write, research into whether the Beers criteria are associated with avoidable ADEs has not generated consistent results.

Hilary Hamilton, M.B., M.R.C.P.I., and colleagues from University College Cork in Ireland had developed STOPP as an alternate way to address the potentially inappropriate medications in older patients. In this study, they compared STOPP and the Beers criteria in terms of the prevalence of ADEs associated with potentially inappropriate medications, including those resulting in hospital admission. Their prospective study included 600 consecutive patients ages 65 years or older admitted to a university hospital. The researchers examined the patient’s preadmission medication regimens and clinical profile, then applied the STOPP and Beers criteria to determine whether any agents were potentially inappropriate medications. The only ADEs noted were those that occurred after exposure to potentially inappropriate medications but before hospital management. Incidents were analyzed for ADEs against World Health Organization–Uppsala Monitoring Centre criteria, and ADE avoidability against Hallas criteria.

A total of 329 ADEs were detected in 158 of the 600 patients. Of those, 219 ADEs were determined to have played a part in the patient’s admission to the hospital; 68.9 percent (151) of these were determined to be avoidable or potentially avoidable. When STOPP criteria were applied, researchers found that serious, avoidable ADEs were identified more often (170 ADEs, or 51.7 percent) than when Beers criteria (67 ADEs, or 20.4 percent) were applied.

According to the authors, the results suggest that STOPP criteria were more likely than Beers criteria to reveal ADEs in general, avoidable, or potentially avoidable ADEs, and ADEs that may have factored into the patient’s hospitalization. “We believe that this finding strengthens the argument for the use of STOPP criteria in everyday clinical practice as a means of reducing the risk of ADEs in older patient,” they write. In addition to calling for further research, the authors state, “Given the current data showing that PIMs are clinically significant in relation to ADEs, application of the STOPP criteria to drug prescribing and dispensing in older people could be highly valuable as a routine screening tool.”

Material adapted from JAMA.

Reference
Arch Intern Med. 2011;171[11]:1013-1019.

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