Potentially inappropriate drug prescription in older subjects across health care settings

Objective. - Potentially inappropriate prescription of drugs is frequent in older subjects, but may vary in different health care settings and with the use of different criteria. We compared the performance of two different tools (Beers and STOPP-START) in the detection of potentially inappropriate drugs and prescribing omissions of appropriate drugs in older patients cared in three different settings. Method. - STOPP-START and Beers criteria were used in 50 consecutive outpatients seen in a hospital geriatric clinic (HC), 50 random patients of a public primary care (PC) clinic, and 50 random patients living in an assisted nursing home (NH). Results. - Mean age increased with the complexity of the setting (from 78.8 years in PC to 84.5 years in NH patients), as did the number of females (from 46% in PC to 76% in NH). STOPP criteria detected more cases of potentially inappropriate prescription than Beers criteria (47% vs 23%, p < 0.001). Beers criteria detected potentially inappropriate drugs in 24% (PC), 26% (HC) and 20% (NH) of the subjects (p = 0.92 for the difference between settings). STOPP criteria detected potentially inappropriate drugs in 36% (PC), 54% (HC) and 50% (NH) of the subjects (p = 0.22 for the difference). The number of subjects with two or more inappropriate prescriptions was higher with STOPP (16%) than with Beers criteria (5%. P = 0.003). START criteria found that 28% (PC), 54% (HC) and 46% (NH) of the subjects were not receiving drugs indicated for some diseases (p = 0.022 for the difference between settings). Conclusions. - STOPP criteria detected a higher number of subjects with potentially inappropriate drug prescription than Beers criteria in all health care settings, although there were some differences across settings. START criteria also showed different performance in each setting. (C) 2010 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.