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Explicit Criteria for Potentially Inappropriate Medications to Reduce the Risk of Adverse Drug Reactions in Elderly People

From Beers to STOPP/START Criteria

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Abstract

Balanced and safe prescribing is difficult to achieve in frail older adults with multiple comorbid diseases. For this reason, great efforts have been made in the search for interventions to improve efficacy, safety and appropriateness of prescriptions in this vulnerable population. Among these interventions, the avoidance of medications that are considered to be inappropriate, i.e. potentially inappropriate medications (PIMs), has been considered a valuable treatment option. The aim of the present review was to summarize evidence about the use of explicit criteria for PIMs to reduce the risk of adverse drug reactions (ADRs) in older people. A PIM is a drug in which the risk of an adverse event outweighs its clinical benefit, particularly when there is evidence in favour of a safer or more effective alternative therapy for the same condition. Explicit criteria have been developed to identify PIMs, and among these, the Beers criteria have been the most frequently applied until recently. However, evidence suggests that such criteria can not easily be applied in European countries: several drugs listed in the 2003 Beers criteria were rarely prescribed or were not available in Europe and 2003 Beers-listed PIMs were not associated with ADRs in some studies. In the past few years, START/STOPP criteria have been developed and applied in several different studies and populations showing a greater ability to predict ADRs with respect to Beers criteria and to prevent potentially inappropriate prescribing. In 2012, Beers criteria have been updated using an evidence-based approach and future studies will investigate the impact of these and other criteria coming from ongoing studies on clinical outcomes relevant to geriatric populations.

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Authors and Affiliations

  1. Unit of Geriatric Pharmacoepidemiology, Italian National Research Center on Aging (INRCA), C.da Muoio Piccolo, I-87100, Cosenza, Italy

    Andrea Corsonello

  2. Department of Gerontology and Geriatrics, Catholic University of Sacred Heart, Roma, Italy

    Graziano Onder

  3. Scientific Direction, Italian National Research Center on Aging (INRCA), Ancona, Italy

    Angela Marie Abbatecola & Fabrizia Lattanzio

  4. Unit of Pulmonary Rehabilitation, Italian National Research Center on Aging (INRCA), Casatenovo, Italy

    Enrico Eugenio Guffanti

  5. Elderly Care Unit, ASP, Catanzaro, Italy

    Piero Gareri

Authors
  1. Andrea Corsonello
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  2. Graziano Onder
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  3. Angela Marie Abbatecola
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  4. Enrico Eugenio Guffanti
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  5. Piero Gareri
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  6. Fabrizia Lattanzio
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Correspondence to Andrea Corsonello.

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Corsonello, A., Onder, G., Abbatecola, A.M. et al. Explicit Criteria for Potentially Inappropriate Medications to Reduce the Risk of Adverse Drug Reactions in Elderly People. Drug Saf 35 (Suppl 1), 21–28 (2012). https://doi.org/10.1007/BF03319100

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