Potentially inappropriate prescribing in elderly: a comparison of Beers and STOPP criteria in tertiary care

Akanksha Mathur, Prashant C. Shah


Background: Prescribing in elderly is a challenging task as they have age related physiological changes, various co-morbidities, altered pharmacological properties and higher propensity for adverse events. They are often prescribed medications which are potentially inappropriate for them, sometimes may even be unnecessary. The medicines are considered as inappropriate if the risk associated with them outweighs benefits. The objective of this study is to assess the prevalence of potentially inappropriate medications (PIM) at a tertiary care teaching hospital according to the Beers updated 2015 criteria and STOPP criteria and to compare the two criteria in detection of PIMs.

Methods: A prospective observational study involving 228 elderly patients (>65years) of medicine wards was conducted from October 2015 to March 2016. Relevant information was recorded in a predesigned proforma. The use of potentially inappropriate medications is assessed using Beers updated 2015 criteria and STOPP criteria using descriptive statistics.

Results: The prevalence of PIM use in the sample was 26.31% according to the 2015 Beers criteria and 14.03% using the STOPP criteria. The most prevalent PIM according to the Beers criteria were sliding scale insulin (17.54%) and long acting benzodiazepines (5.26%); according to the STOPP criteria, they were aspirin in heart failure (5.26%) and chlorpheniramine (3.07%).

Conclusions: The prevalence of PIM varied when different criteria were applied. The 2015 Beers criteria identified more PIM than the STOPP criteria.


Beers criteria, Geriatrics, Potentially inappropriate medications, STOPP criteria

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Sandhiya S, Adithan C. Drug Therapy in the Elderly. J Assoc Physicians India. 2008;56:525-31.

Noble RE. Drug therapy in the elderly. Metabolism. 2003;52(10 Suppl 2):27-30.

Renom-Guiteras A, Meyer G, Thürmann PA. The EU (7)-PIM list: a list of potentially inappropriate medications for older people consented by experts from seven European countries. Eur J Clin Pharmacol. 2015 Jul 1;71(7):861-75.

Osei EK, Berry-Cabán CS, Haley CL, Rhodes-Pope H. Prevalence of Beers criteria medications among elderly patients in a military hospital. Gerontol Geriatric Med. 2016 Mar 12;2:2333721416637790.

de Lima TJV. Garbin CAS. Garbin AJI, Sumida DH. Saliba O. Potentially inappropriate medications used by the elderly: prevalence and risk factors in Brazilian care homes. BMC Geriat. 2013;13:52.

Shah KN, Joshi HM, Christian RP, Patel KP, Malhotra SD. Prevalence of potentially inappropriate medications and prescription cost analysis among older cardiac patients in an outpatient department of a tertiary care hospital in India. J Basic Clin Pharmacy. 2016 Sep;7(4):110-5.

Chang CB, Chen JH, Wen CJ, Kuo HK, Lu IS, Chiu LS, et al. Potentially inappropriate medications in geriatric outpatients with polypharmacy: application of six sets of published explicit criteria. Br J Clin Pharmacol. 2011 Sep;72(3):482-9.

Dalleur O, Boland B, De Groot A, Vaes B, Boeckxstaens P, Azermai M, et al. Detection of potentially inappropriate prescribing in the very old: cross-sectional analysis of the data from the BELFRAIL observational cohort study. BMC Geriatrics. 2015 Dec;15(1):156.

Gallagher P, O’Mahony D. STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions): application to acutely ill elderly patients and comparison with Beers’ criteria. Age Ageing. 2008 Oct 1;37(6):673-9.

Ryan C, O'mahony D, Kennedy J, Weedle P, Byrne S. Potentially inappropriate prescribing in an Irish elderly population in primary care. Br J Clin Pharmacol. 2009 Dec 1;68(6):936-47.

Oliveira MG, Amorim WW, de Jesus SR, Heine JM, Coqueiro HL, Passos LC. A comparison of the Beers and STOPP criteria for identifying the use of potentially inappropriate medications among elderly patients in primary care. J Evaluation Clin Practice. 2015 Apr;21(2):320-5.

The American Geriatrics Society. American geriatrics society 2015 updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015 Nov;63(11):2227-46.

O'mahony D, O'sullivan D, Byrne S, O'connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015 Mar 1;44(2):213-8.

Goudanavar P, Keerthi Y, Jacob J, Krishna R. A Prospective Study on Medication Prescribing Pattern for Geriatric Patients in a Tertiary Care Teaching Hospital. Asian J Biomed Pharmaceut Sci. 2016 Jun 10;6(56).

Abraham F, Varughese G, Mathew JC, John PM, Sam GK. Drug utilization pattern among geriatric patients in a tertiary care teaching hospital. Asian J Pharm Clin Res. 2015;8(6):191-4.

Jhaveri BN, Patel TK, Barvaliya MJ, Tripathi CB. Drug utilization pattern and pharmacoeconomic analysis in geriatric medical in-patients of a tertiary care hospital of India. J Pharmacol Pharmacotherapeut. 2014 Jan;5(1):15-20.

Ramesh KT, Shahina S, Shobha JC, Naidu MU. Usha Rani, 192 Vijay T. Drug utilization in geriatric population in a tertiary care 193 center. JK science. 1999;3:118-20.

Shah RB, Gajjar BM, Desai SV. Drug utilization pattern among geriatric patients assessed with the anatomical therapeutic chemical classification/defined daily dose system in a rural tertiary care teaching hospital. Int J Nutr Pharmacol Neurological Dise. 2012 Sep 1;2(3):258-65.

Shankar PR, Upadhyay DK, Subish P, Bhandari RB, Das B. Drug utilisation among older inpatients in a teaching hospital in Western Nepal. Singapore Med J. 2010 Jan 1;51(1):28-34.

Sah AK, Jha RK, Sah P, Basnet S. Potentially inappropriate prescribing in elderly population: A study in medicine out-patient department. J Coll Med Sci-Nepal. 2017 Jan 1;13(1):197-202.

Van der Hooft CS, Schoofs MW, Ziere G, Hofman A, Pols HAP, Sturkenboom MC, et al. Inappropriate benzodiazepine use in older adults and the risk of fracture. Br J Clin Pharmacol. 2008 Aug;66(2):276-82.

Currie GM, Wheat JM, Kiat H. Pharmacokinetic considerations for digoxin in older people. Open Cardiovas Med J. 2011;5:130-5.

Nagendra Vishwas H, Harugeri A, Parthasarathi G, Ramesh M. Potentially inappropriate medication use in Indian elderly: Comparison of Beers' criteria and screening tool of older persons' potentially inappropriate Prescriptions. Geriatrics Gerontol Int. 2012 Jul;12(3):506-14.

Lim YJ, Kim HY, Choi J, Lee JS, Ahn AL, Oh EJ, et al. Potentially inappropriate medications by beers criteria in older outpatients: prevalence and risk factors. Korean J Famy Med. 2016 Nov 1;37(6):329-33.