title: Potentially inappropriate prescribing detected by STOPP-START criteria: are they really inappropriate?
abstract: BACKGROUND
  the STOPP-START criteria were developed to detect potentially inappropriate prescribing (PIP) in older people. The reasons why multidisciplinary geriatric teams decide not to follow STOPP-START criteria have not been studied.
  
  
  OBJECTIVE
  to analyse compliance with the recommendations of the STOPP-START criteria in older inpatients.
  
  
  METHODS
  ambispective, non-randomised study. SUBJECTS SETTING: three hundred and eighty-eight consecutive patients aged 80 years or over admitted to the acute geriatric medicine unit of a University hospital.
  
  
  METHODS
  STOPP-START criteria were systematically used by a pharmacist to assess pre-admission treatments, and the multidisciplinary geriatric team decided what drugs were recommended after discharge. Two researches independently assessed how many STOPP-START recommendations were accepted by the team, and if they were not accepted, why.
  
  
  RESULTS
  two hundred and eighty-four PIPs were identified (0.8 per subject) according to STOPP criteria. Two hundred and forty-seven of these prescriptions (87.0%) were discontinued at discharge. STOPP recommendations were not accepted in 37 cases, mostly because the team considered other therapeutic priorities (lorazepam, n = 12; risperidone, n = 5; other, n = 18). Three hundred and ninety-seven PIPs were identified according to START criteria (1.1 per subject). START recommendations were not followed at discharge in 264 cases (66.5%). The most frequent reasons were as follows: severe disability (n = 90), the use of other effective treatments for the condition (n = 38) and high risk of severe adverse effects (n = 32). Not following START criteria was significantly associated with dependency for basic activities of daily living (ADLs) (odds ratio, OR: 0.66 for compliance with a recommendation; 0.49-0.89), dependency for instrumental ADLs (OR: 0.64; 0.48-0.85) or inability to walk (OR: 0.72; 0.54-0.98).
  
  
  CONCLUSIONS
  potentially inappropriate drugs are usually discontinued, but many older hospitalised patients do not receive potentially recommended medications. More research on the reasons and consequences of this fact is needed.
authors.affiliation: Servicio de Geriatria, Hospital Universitario Ramón y Cajal, Madrid, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Lozano-Montoya
authors.affiliation: Servicio de Farmacia Hospitalaria, Hospital Universitario Ramón y Cajal, Madrid, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Vélez-Diaz-Pallarés
authors.affiliation: Servicio de Farmacia Hospitalaria, Hospital Universitario Ramón y Cajal, Madrid, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Delgado-Silveira
authors.affiliation: Servicio de Geriatria, Hospital Universitario Ramón y Cajal, Madrid, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Montero-Errasquin
authors.affiliation: Servicio de Geriatria, Hospital Universitario Ramón y Cajal, Madrid, Spain.
authors.forename: Alfonso Jose
authors.initials: AJ
authors.lastname: Cruz Jentoft
mesh_terms: D000369:Aged, 80 and over; D004185:Disability Evaluation; D004347:Drug Interactions; D064420:Drug-Related Side Effects and Adverse Reactions / Q000209:etiology / Q000517:prevention & control; D005260:Female; D015577:Geriatric Assessment; D005853:Geriatrics / Q000592:standards; D019983:Guideline Adherence; D006785:Hospitals, University; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D008297:Male; D059065:Medication Reconciliation; D016017:Odds Ratio; D010348:Patient Care Team; D010351:Patient Discharge; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain
keywords: STOPP/START; older people; potentially inappropriate prescribing