title: STOPP/START criteria for potentially inappropriate prescribing in older people: version 2.
abstract: OBJECTIVE
  Screening tool of older people's prescriptions (STOPP) and screening tool to alert to right treatment (START) criteria were first published in 2008. Due to an expanding therapeutics evidence base, updating of the criteria was required.
  
  
  METHODS
  We reviewed the 2008 STOPP/START criteria to add new evidence-based criteria and remove any obsolete criteria. A thorough literature review was performed to reassess the evidence base of the 2008 criteria and the proposed new criteria. Nineteen experts from 13 European countries reviewed a new draft of STOPP & START criteria including proposed new criteria. These experts were also asked to propose additional criteria they considered important to include in the revised STOPP & START criteria and to highlight any criteria from the 2008 list they considered less important or lacking an evidence base. The revised list of criteria was then validated using the Delphi consensus methodology.
  
  
  RESULTS
  The expert panel agreed a final list of 114 criteria after two Delphi validation rounds, i.e. 80 STOPP criteria and 34 START criteria. This represents an overall 31% increase in STOPP/START criteria compared with version 1. Several new STOPP categories were created in version 2, namely antiplatelet/anticoagulant drugs, drugs affecting, or affected by, renal function and drugs that increase anticholinergic burden; new START categories include urogenital system drugs, analgesics and vaccines.
  
  
  CONCLUSIONS
  STOPP/START version 2 criteria have been expanded and updated for the purpose of minimizing inappropriate prescribing in older people. These criteria are based on an up-to-date literature review and consensus validation among a European panel of experts.
authors.affiliation: Geriatric Medicine, University College Cork, Cork, Munster, Ireland Geriatric Medicine, Cork University Hospital, Cork, Munster, Ireland.
authors.forename: Denis
authors.initials: D
authors.lastname: O'Mahony
authors.affiliation: School of Pharmacy, University College Cork, Cork, Munster, Ireland.
authors.forename: David
authors.initials: D
authors.lastname: O'Sullivan
authors.affiliation: School of Pharmacy, University College Cork, Cork, Munster, Ireland.
authors.forename: Stephen
authors.initials: S
authors.lastname: Byrne
authors.affiliation: Geriatric Medicine, Cork University Hospital, Cork, Munster, Ireland.
authors.forename: Marie Noelle
authors.initials: MN
authors.lastname: O'Connor
authors.affiliation: School of Pharmacy, Queen's University, Belfast, Northern Ireland, UK.
authors.forename: Cristin
authors.initials: C
authors.lastname: Ryan
authors.affiliation: Geriatric Medicine, Cork University Hospital, Cork, Munster, Ireland.
authors.forename: Paul
authors.initials: P
authors.lastname: Gallagher
mesh_terms: D000367:Age Factors; D032921:Consensus; D003697:Delphi Technique; D004347:Drug Interactions; D011307:Drug Prescriptions; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D005060:Europe; D019317:Evidence-Based Medicine / Q000592:standards; D006299:Health Services for the Aged / Q000592:standards*; D006801:Humans; D057970:Inappropriate Prescribing; D010818:Practice Patterns, Physicians' / Q000592:standards*
keywords: STOPP/START criteria; inappropriate prescribing; older people