STOPP criteria work better than Beers

Adverse drug events in elderly patients could potentially be reduced by use of the STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions) criteria, a new study suggested.

The prospective study included 600 patients 65 years or older admitted to an Irish teaching hospital. Researchers observed 329 adverse drug events in the records of 158 of the patients. About 66% of those adverse events had contributed to or caused the hospital admission, according to the researchers' evaluation. Of those causal/contributory events, 68.9% were avoidable or potentially avoidable. The study was published in the June 13 Archives of Internal Medicine.

The study authors then compared the drugs that had caused the adverse events with two established criteria for avoiding potentially inappropriate medications in elderly patients—the STOPP and the Beers criteria. They found that the drugs involved in the adverse events were 2.54 times more likely to meet STOPP criteria than Beers criteria. Looking only at the events that were avoidable and contributory to the hospitalization, the researchers found that they were 2.8 times more likely to be on the STOPP list (P<0.001).

After adjustment for a number of factors, the researchers found that patients taking a medication on the STOPP list were 85% more likely to have an adverse drug event than those who weren't (odds ratio, 1.847; 95% CI, 1.506 to 2.264; P<0.001). No significant association was found with the Beers criteria. The results strengthen the argument for using STOPP criteria as a routine screening tool in everyday clinical practice, the authors concluded. Further research is needed to determine definitively whether use of the STOPP reduces adverse events, medication costs and health care utilization, the authors said.

Tools such as STOPP cannot capture all potentially inappropriate prescribing, the authors cautioned, and should be used to enhance, rather than replace, clinical judgment in prescribing for older patients. An accompanying commentary also noted that tools have to be implemented effectively to provide benefit. Greater incorporation of electronic prescribing into clinicians' workflows should help with this, the commentary author wrote. He also suggested that future research assess any unintended consequences of efforts to avoid potentially dangerous medications, for example, pain in a patient taken off opiate therapy to reduce the risk of falls.