Drugs & Aging

, Volume 29, Issue 6, pp 437–452 | Cite as

Inappropriate Prescribing

Criteria, Detection and Prevention
  • Marie N. O’ConnorEmail author
  • Paul Gallagher
  • Denis O’Mahony
Review Article


Inappropriate prescribing is highly prevalent in older people and is a major healthcare concern because of its association with negative healthcare outcomes including adverse drug events, related morbidity and hospitalization. With changing population demographics resulting in increasing proportions of older people worldwide, improving the quality and safety of prescribing in older people poses a global challenge.

To date a number of different strategies have been used to identify potentially inappropriate prescribing in older people. Over the last two decades, a number of criteria have been published to assist prescribers in detecting inappropriate prescribing, the majority of which have been explicit sets of criteria, though some are implicit. The majority of these prescribing indicators pertain to overprescribing and misprescribing, with only a minority focussing on the underprescribing of indicated medicines. Additional interventions to optimize prescribing in older people include comprehensive geriatric assessment, clinical pharmacist review, and education of prescribers as well as computerized prescribing with clinical decision support systems.

In this review, we describe the inappropriate prescribing detection tools or criteria most frequently cited in the literature and examine their role in preventing inappropriate prescribing and other related healthcare outcomes. We also discuss other measures commonly used in the detection and prevention of inappropriate prescribing in older people and the evidence supporting their use and their application in everyday clinical practice.


Comprehensive Geriatric Assessment Inappropriate Medication Inappropriate Prescribe Potential Inappropriate Prescribe Beers Criterion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Authors Dr Gallagher and Dr O’Mahony developed the inappropriate prescribing tools STOPP and START.

No sources of funding were used to assist in the preparation of this article. The authors have no conflicts of interest that are directly relevant to the content of this article.


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Copyright information

© Springer International Publishing AG 2012

Authors and Affiliations

  • Marie N. O’Connor
    • 1
    Email author
  • Paul Gallagher
    • 1
    • 2
  • Denis O’Mahony
    • 1
    • 2
  1. 1.Department of Geriatric MedicineCork University HospitalWiltonIreland
  2. 2.School of MedicineUniversity College CorkIreland

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