Usefulness of STOPP/START criteria to assess appropriateness of medicines prescribed to older adults in a resource-limited setting

  • U. G. S. Siripala
  • S. P. K. Premadasa
  • N. R. Samaranayake
  • C. A. WanigatungeEmail author
Research Article


Background There is a dearth of published data from resource-limited settings on appropriateness of medicines in older adults using explicit criteria, but it is unclear if the STOPP/START criteria can be helpful. Objective To assess the usefulness of STOPP/START criteria in assessing appropriateness of medicines in a resource-limited setting. Setting Medical, diabetic and psychiatric clinics of a tertiary care hospital and elderly living in a selected locality in Colombo district. Method A descriptive cross-sectional study was conducted over a 2 months period among adults > 60 years on long-term medicines. ‘Screening tool of older person’s prescriptions’ (STOPP) and ‘screening tool to alert doctors to right treatment’ (START) criteria were used to assess appropriateness of medicines. Main outcome measures Potentially inappropriate medicines (PIMs) and potential prescription omissions (PPOs). Results A total of 468 patients prescribed with 2841 medicines were analysed. PIMs were seen among 167 (35.7%) patients, while PPOs were seen among 289 (61.8%) patients. Incomplete documentation in health records, especially the absence of renal function status (53.7%), was a barrier for accurate assessment of PIMs and PPOs. Some criteria could not be assessed due to differences in the healthcare settings and resources available. Conclusions Inappropriate prescribing to older adults was a problem in the selected settings. Use of explicit criteria to detect inappropriate prescribing is important, but should be modified to suit the local context. Documentation in medical records should be improved to allow for better assessment of appropriateness of medicines.


Medicines appropriateness Older adults Resource-limited settings Sri Lanka STOPP/START criteria 



We thank the Director and Clinic Staff of the study hospital and the Grama Niladhari of the selected community study area for the assistance given.


The project was funded by a research grant from the University of Sri Jayewardenepura (ASP/01/RE/MED/2015/46).

Conflicts of interest

The authors declare that they have no conflicts of interest.

Supplementary material

11096_2019_786_MOESM1_ESM.pdf (91 kb)
Supplementary material 1 (PDF 91 kb)


  1. 1.
    Mangoni AA, Jackson SH. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol. 2004;57:6–14.CrossRefGoogle Scholar
  2. 2.
    Reason B, Terner M, McKeag AM, Tipper B, Webster G. The impact of polypharmacy on the health of Canadian seniors. Fam Pract. 2012;29:427–32.CrossRefGoogle Scholar
  3. 3.
    Konrat C, Boutron I, Trinquart L, Auleley GR, Ricordeau P, Ravaud P. Underrepresentation of elderly people in randomized controlled trials. The example of trials of 4 widely prescribed drugs. PLoS ONE. 2012;7:e33559.CrossRefGoogle Scholar
  4. 4.
    Cahir C, Fahey T, Teeling M, Teljeur C, Feely J, Bennett K. Potentially inappropriate prescribing and cost outcomes for older people: a national population study. Br J Clin Pharmacol. 2010;69:543–52.CrossRefGoogle Scholar
  5. 5.
    Moriarty F, Bennett K, Cahir C, Kenny RA, Fahey T. Potentially inappropriate prescribing according to STOPP and START and adverse outcomes in community-dwelling older people: a prospective cohort study. Br J Clin Pharmacol. 2016;82:849–57.CrossRefGoogle Scholar
  6. 6.
    Wahab MSA, Nyfort-Hansen K, Kowalski SR. Inappropriate prescribing in hospitalized Australian elderly as determined by the STOPP criteria. Int J Clin Pharm. 2012;34:855–62.CrossRefGoogle Scholar
  7. 7.
    Chang CB, Chang DC. Comparison of published explicit criteria for potentially inappropriate medications in older adults. Drugs Aging. 2010;27:947–57.CrossRefGoogle Scholar
  8. 8.
    Opondo D, Eslami S, Visscher S, de Rooij SE, Verheij R, Korevar JC, et al. Inappropriateness of medication prescriptions to elderly patients in the primary care setting: a systematic review. PLoS ONE. 2012;7:e43617.CrossRefGoogle Scholar
  9. 9.
    Elliott RA, Stehlik P. Identifying inappropriate prescribing for older people. J Pharm Pract Res. 2013;43:312–9.CrossRefGoogle Scholar
  10. 10.
    Levy HB, Marcus EL, Christen C. Beyond the beers criteria: a comparative overview of explicit criteria. Ann Pharmacother. 2012;44:1968–75.CrossRefGoogle Scholar
  11. 11.
    Gallagher P, Ryan C, Byrne S, Kennedy J, O’Mahony D. STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther. 2008;46:72–83.CrossRefGoogle Scholar
  12. 12.
    Gallagher P, Lang PO, Cherubini A, Topinková E, Cruz-Jentoft A, Errasquín BM, et al. Prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals. Eur J Clin Pharmacol. 2011;67:1175–88.CrossRefGoogle Scholar
  13. 13.
    Liu CL, Peng LN, Chen YT, Lin MH, Liu LK, Chen LK. Potentially inappropriate prescribing (IP) for elderly medical inpatients in Taiwan: a hospital-based study. Arch Gerontol Geriatr. 2012;55:148–51.CrossRefGoogle Scholar
  14. 14.
    Brahmbhatt M, Palla K, Kossifologos A, Mitchell D, Lee T. Appropriateness of medication prescribing using the STOPP/START criteria in veterans receiving home-based primary care. Consult Pharm. 2013;28:361–9.CrossRefGoogle Scholar
  15. 15.
    Tommelein E, Mehuys E, Petrovic M, Somers A, Colin P, Boussery K. Potentially inappropriate prescribing in community-dwelling older people across Europe: a systematic literature review. Eur J Clin Pharmacol. 2015;71:1415–27.CrossRefGoogle Scholar
  16. 16.
    Karandikar YS, Chaudhari SR, Dalal NP, Sharma M, Pandit VA. Inappropriate prescribing in the elderly: a comparison of two validated screening tools. J Clin Gerontol Geriatr. 2013;4:109–14.CrossRefGoogle Scholar
  17. 17.
    Census of population and housing—2012 final report Accessed August 2018.
  18. 18.
  19. 19.
    National List of Essential Medicines Sri Lanka (2013–2014). Accessed August 2018.
  20. 20.
    Lee S-J, Cho S-W, Lee YJ, Choi JH, Ga H, Kim YH, et al. Survey of potentially inappropriate prescription using STOPP/START criteria in Inha University Hospital. Korean J Family Med. 2013;34:319–26.CrossRefGoogle Scholar
  21. 21.
    Wanigatunge C, Hewahetawatta U, Dissanayake D. Non communicable diseases and medicines use in elderly attending public sector hospitals in Sri Lanka. Asian J Pharm Nurs Med Sci. 2014;2:99–106.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Ministry of Health, Nutrition and Indigenous MedicineColomboSri Lanka
  2. 2.Department of Allied Health Sciences, Faculty of Medical SciencesUniversity of Sri JayewardenepuraNugegodaSri Lanka
  3. 3.Department of Pharmacology, Faculty of Medical SciencesUniversity of Sri JayewardenepuraNugegodaSri Lanka

Personalised recommendations