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      Potentially Inappropriate Medications in Elderly Haemodialysis Patients Using the STOPP Criteria

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          Abstract

          Background

          Polypharmacy is commonly applied to elderly haemodialysis patients for treating terminal renal failure and multiple co-morbidities. Potentially inappropriate medications (PIMs) in multidrug regimens in geriatric populations can be identified using specially designed screening tools.

          Objective

          The aims of this study were to estimate the prevalence of PIMs by applying the Screening Tool of Older Persons’ Prescriptions (STOPP) criteria and the Beers criteria to elderly haemodialysis patients and to assess the association of some risk factors with the presence of PIMs.

          Methods

          Fifty-one elderly haemodialysis patients participated; their median age was 74 (range 65–89) years, and 77 % of them were male. Demographic data, co-morbidity and medication lists were collected from the electronic medical records of the patients. The STOPP criteria were applied by two physicians independently to identify PIMs. The association of some risk factors with PIMs were assessed using Fisher’s exact test.

          Results

          The patients used a median of 13 (range 7–21) medications per day. The overall prevalence of PIMs using the STOPP criteria was 63 %, and using the Beers criteria was 43 %. The most prevalent PIMs were proton-pump inhibitors. Benzodiazepines and first-generation antihistamines were related to side effects such as falls in the previous 3 months, and calcium-channel blockers were associated with chronic constipation. The number of PIMs was not significantly associated with number of medications, age, sex and co-morbidity.

          Conclusions

          The STOPP criteria revealed a high prevalence of PIMs in a population of elderly patients receiving haemodialysis.

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          Most cited references21

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          Practical statistics for medical research. Douglas G. Altman, Chapman and Hall, London, 1991. No. of pages: 611. Price: £32.00

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            STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation.

            Older people experience more concurrent illnesses, are prescribed more medications and suffer more adverse drug events than younger people. Many drugs predispose older people to adverse events such as falls and cognitive impairment, thus increasing morbidity and health resource utilization. At the same time, older people are often denied potentially beneficial, clinically indicated medications without a valid reason. We aimed to validate a new screening tool of older persons' prescriptions incorporating criteria for potentially inappropriate drugs called STOPP (Screening Tool of Older Persons' Prescriptions) and criteria for potentially appropriate, indicated drugs called START (Screening Tool to Alert doctors to Right, i.e. appropriate, indicated Treatment). A Delphi consensus technique was used to establish the content validity of STOPP/START. An 18-member expert panel from academic centers in Ireland and the United Kingdom completed two rounds of the Delphi process by mail survey. Inter-rater reliability was assessed by determining the kappa-statistic for measure of agreement on 100 data-sets. STOPP is comprised of 65 clinically significant criteria for potentially inappropriate prescribing in older people. Each criterion is accompanied by a concise explanation as to why the prescribing practice is potentially inappropriate. START consists of 22 evidence-based prescribing indicators for commonly encountered diseases in older people. Inter-rater reliability is favorable with a kappa-coefficient of 0.75 for STOPP and 0.68 for START. STOPP/START is a valid, reliable and comprehensive screening tool that enables the prescribing physician to appraise an older patient's prescription drugs in the context of his/her concurrent diagnoses.
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              Potentially inappropriate medications defined by STOPP criteria and the risk of adverse drug events in older hospitalized patients.

              Previous studies have not demonstrated a consistent association between potentially inappropriate medicines (PIMs) in older patients as defined by Beers criteria and avoidable adverse drug events (ADEs). This study aimed to assess whether PIMs defined by new STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions) criteria are significantly associated with ADEs in older people with acute illness. We prospectively studied 600 consecutive patients 65 years or older who were admitted with acute illness to a university teaching hospital over a 4-month interval. Potentially inappropriate medicines were defined by both Beers and STOPP criteria. Adverse drug events were defined by World Health Organization-Uppsala Monitoring Centre criteria and verified by a local expert consensus panel, which also assessed whether ADEs were causal or contributory to current hospitalization. Hallas criteria defined ADE avoidability. We compared the proportions of patients taking Beers criteria PIMs and STOPP criteria PIMs with avoidable ADEs that were causal or contributory to admission. A total of 329 ADEs were detected in 158 of 600 patients (26.3%); 219 of 329 ADEs (66.6%) were considered causal or contributory to admission. Of the 219 ADEs, 151 (68.9%) considered causal or contributory to admission were avoidable or potentially avoidable. After adjusting for age, sex, comorbidity, dementia, baseline activities of daily living function, and number of medications, the likelihood of a serious avoidable ADE increased significantly when STOPP PIMs were prescribed (odds ratio, 1.847; 95% confidence interval [CI], 1.506-2.264; P < .001); prescription of Beers criteria PIMs did not significantly increase ADE risk (odds ratio, 1.276; 95% CI, 0.945-1.722; P = .11). STOPP criteria PIMs, unlike Beers criteria PIMs, are significantly associated with avoidable ADEs in older people that cause or contribute to urgent hospitalization.
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                Author and article information

                Contributors
                +47-679-69367 , krystina.parker@medisin.uio.no
                Journal
                Drugs Real World Outcomes
                Drugs Real World Outcomes
                Drugs - Real World Outcomes
                Springer International Publishing (Cham )
                2199-1154
                2198-9788
                8 August 2016
                8 August 2016
                September 2016
                : 3
                : 3
                : 359-363
                Affiliations
                [1 ]Medical Division, Department of Nephrology, Akershus University Hospital, 1478 Lørenskog, Norway
                [2 ]Institute of Clinical Medicine, University of Oslo, Oslo, Norway
                [3 ]Medical Division, Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway
                [4 ]HØKH, Department of Health Services Research, Akershus University Hospital, Lørenskog, Norway
                Author information
                http://orcid.org/0000-0003-3293-6842
                Article
                88
                10.1007/s40801-016-0088-z
                5042944
                79a09b20-8f37-4847-a8c4-c87975b84a38
                © The Author(s) 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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                © The Author(s) 2016

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