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Potentially inappropriate prescribing in a falls clinic using the STOPP and START criteria

International Journal of Clinical Pharmacy volume 44, pages 163–171 (2022)Cite this article

Abstract

Background Potentially inappropriate prescribing is increasingly common in older patients with falls. However, published indicators to assess inappropriate prescribing remains unestablished in many countries. Objective This study determined the burden and profile of potentially inappropriate prescribing among patients attending a falls clinic using the STOPP/START criteria and evaluated the factors for falls potentially associated to inappropriate prescribing. Setting University of Malaya Medical Centre Falls Clinic. Method Data of individuals aged ≥ 65 years referred to the falls and syncope clinic were extracted from the falls registry. Potentially inappropriate prescribing was determined with the STOPP/START version 2 criteria. The relationship between potentially inappropriate prescribing with polypharmacy (≥ 5 medications), comorbidities and clinical variables were determined using Pearson’s chi-square and potential confounders adjusted for with multivariate regression. Main outcome measure Potentially inappropriate medicines and/or omitted medicines using STOPP/START criteria. Results Data from 421 individuals, aged 77.8 ± 6.7 years and 53.4% women, were included. Potentially inappropriate prescribing was present in 311 (73.9%). Potentially inappropriate medicines use accounted for 84.6% of the 325 prescriptions. 361/659 instances (54.8%) were falls-risk-increasing drugs, with vasodilators (49.3%) being the main potentially inappropriate medicine identified. Of the 177/421 with polypharmacy, 169/177 (95.5%) were exposed to ≥ one potentially inappropriate medicine. 129 instances of potentially omitted medicines were observed in 109 prescriptions (25.9%). Conclusion STOPP/START criteria are useful to identify potentially inappropriate prescribing at the falls and syncope clinic. This finding has important implications for medication review strategies at falls clinic. Future research should determine whether identifying potentially inappropriate prescribing may reduce adverse falls outcomes among patients in this setting.

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Acknowledgements

All the authors listed have had a significant role in the execution of the project and drafting of the manuscript. We would like to acknowledge the Falls and Syncope Service, University of Malaya Medical Centre for providing the falls data.

Funding

This work was supported by an Impactful Interdisciplinary Research Grant (lIRG024A-2019) awarded by the Health and Wellbeing Research Cluster, University of Malaya.

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Authors and Affiliations

  1. Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia

    Rosalind Chiam, Nor’izzati Saedon, Hui Min Khor & Maw Pin Tan

  2. Falls and Syncope Service, Cardiorespiratory Laboratory, University of Malaya Medical Centre, 59100, Kuala Lumpur, Malaysia

    Sukanya A/P. Subramaniam, Siti Sakinah binti Mohmad Nasir & Noor Fatin Izzati binti Abu Hashim

  3. Department of Medical Sciences, Faculty of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Malaysia

    Maw Pin Tan

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  1. Rosalind Chiam
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Chiam, R., Saedon, N., Khor, H.M. et al. Potentially inappropriate prescribing in a falls clinic using the STOPP and START criteria. Int J Clin Pharm 44, 163–171 (2022). https://doi.org/10.1007/s11096-021-01329-9

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Keywords

  • Accidental falls
  • Adverse drug events
  • Aged
  • Inappropriate prescribing
  • STOPP START criteria