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Following STOPP criteria can decrease adverse drug effects in older patients

Clinical Question:
Are potentially inappropriate medicines as defined by the STOPP criteria associated with avoidable adverse drug events in older people with acute illness?

Bottom Line:
Of 600 consecutive patients older than 65 years admitted for an acute illness, nearly 25% of them had one or more adverse drug events; two thirds of the drug effects contributed to the admission. Of these adverse drug effects, 69% were avoidable. Patients taking medicines listed in the 65 rules of the Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) criteria were significantly more likely to experience an adverse drug event, making this list (available at http://www.em-consulte.com/showarticlefile/245669/main.pdf) the first to be shown to predict the risk of drug events. (LOE = 1b)

Reference:
Hamilton H, Gallagher P, Ryan C, Byrne S, O'Mahony D. Potentially inappropriate medications defined by STOPP criteria and the risk of adverse drug events in older hospitalized patients. Arch Intern Med 2011;171(11):1013-1019.  [PMID:21670370]

Study Design:
Cohort (prospective)

Funding:
Government

Setting:
Inpatient (any location)

Synopsis:
The Irish investigators conducting this study enrolled 600 consecutive patients 65 years or older who were admitted for an acute illness. The patients' medications taken before admission were characterized as potentially inappropriate or not by using both the Beers and STOPP criteria, 2 lists often used to identify potentially inappropriate medicines in older patients. Using World Health Organization--Uppsala Monitoring Centre criteria, adverse drug events were identified before medical management began for the acute illness by 4 experts in geriatric pharmacotherapy, characterized as being (1) causal or contributory to the admission, or (2) incidental or not related to the admission. A total of 329 adverse drug effects were identified in 158 patients; 219 (66.6%) were considered to be causal or contributory to admission. Of these 219, 151 (69%) were avoidable or potentially avoidable. Potentially inappropriate medicines identified by STOPP criteria were significantly associated with adverse effects (odds ratio = 1.85; 95%, 1.5 - 2.3); the Beers criteria did not predict adverse effects.

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