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Objective A significant number of older adults are affected by the use of potentially inappropriate medications (PIMs), leading to various adverse outcomes, such as increased physical and cognitive impairment, frailty, hospitalization, and mortality. The objective of this study was to develop and test the reliability and feasibility of the De-Med tool. Methods This tool was developed using ReactJS for data extraction and manipulation. Users can upload drug lists for analysis, and the software delineates PIMs adhering to the Beers 2019 version, Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) Version 2, and Fit fOR The Aged (FORTA) 2021 criteria. Reliability was assessed by juxtaposing software-generated outputs with manual assessments conducted by independent research pharmacists using retrospective medication records. The System Usability Scale (SUS) and AttrakDiff Mini questionnaires were used to assess feasibility and usability, respectively. Key findings Manual and software-generated PIM identifications agreed completely, demonstrating high reliability (100% concordance). A total of 1496 PIMs were identified from 231 records, with an average of 0.63 encounters per patient. The overall usability score was 83.75, indicating "Excellent." According to the AttrakDiff ratings, users attributed the software to both pragmatic (mean PQ:1.84) and hedonic (mean HQ:1.50) qualities, with moderate overall attractiveness (mean ATT:2.13). Conclusions This web-based tool successfully identified PIMs with perfect reliability, high usability, and a moderate level of attractiveness. This tool has the potential to improve medication management in older adults by reducing PIMs. [ABSTRACT FROM AUTHOR]

Ahmad Al-Azayzih,1 Enas Bani-Ahmad,1 Anan S Jarab,1,2 Zelal Kharaba,2,3 Khalid Al-Kubaisi4 1Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan; 2College of Pharmacy, AL Ain University, Abu Dhabi, United Arab Emirates; 3Honorary Associate Lecturer, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK; 4Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah, United Arab EmiratesCorrespondence: Ahmad Al-Azayzih, Clinical Pharmacy Department, Faculty of Pharmacy-Jordan University of Science and Technology, Irbid, 22110, Jordan, Email aaazayzih@just.edu.joAims of the Study: This study aimed to identify the prevalence and significant predictors of both potentially inappropriate medications (PIMs) and potentially omitted medications (POMs) events among geriatric patients with advanced cancer using the STOPP (Screening Tool of Older Persons’ Prescriptions) and START (Screening Tool to Alert to Right Treatment) criteria.Methods: This retrospective cross-sectional study included patients aged ≥ 65 years who were diagnosed and treated for advanced stage of cancer. Patients’ medical charts were evaluated to identify polypharmacy (≥ 5 medications) prevalence as well as potential PIMs and POMs incidents and their associated predictors. SPSS software was used to perform the analysis. Multivariate logistic regression models were used to identify factors associated with dependent variables including PIMs use and POMs.Results: Electronic medication charts of 510 patients were evaluated. The average age of the patients was 73.25 years, and 264 (51.8%) patients were males. The average number of medications prescribed per patient was 10.3 (range– 2– 26). Polypharmacy was present in 85.9% of patients, while excessive polypharmacy prevalence was 52.2%. At least one PIM was encountered in 253 patients (49.6%), while at least one POM was encountered in all patients owing to the omission of pneumococcal vaccines. The most common PIMs were opioid analgesics, followed by benzodiazepines, and hypnotics. Additionally, the most omitted medications, excluding vaccinations, were cardiovascular agents and laxatives in patients on regular opioid analgesics. Polypharmacy and diagnosis with solid cancer compared to hematological cancer were associated with increased odds for PIMs occurrence (ORs = 1.293 (p < 0.001) and 3.022 (p = 0.03), respectively), while coexistence of hypertension diagnosis in cancer patients was associated with increased the odds for POMs events (OR = 2.286 (p = 0.007)).Conclusion: Polypharmacy, PIMs, and POMs were highly prevalent among older cancer patients based on the polypharmacy definition and STOPP/START Criteria.Keywords: START, STOPP, geriatrics, inappropriate medications, omitted medications, cancer

The demand for long-term care is expected to increase due to the rising life expectancy and the increased prevalence of long-term illnesses. Nursing home residents are at an increased risk of suffering adverse drug events due to inadequate prescriptions. The main objective of this systematic review is to collect and analyze the prevalence of potentially inadequate prescriptions based on the new version of STOPP/START criteria in this specific population. Databases (PubMed, Web of Science and Cochrane) were searched for inappropriate prescription use in nursing homes according to the second version of STOPP/START criteria. The risk of bias was assessed with the STROBE checklist. A total of 35 articles were assessed for eligibility. One hundred and forty nursing homes and more than 6900 residents were evaluated through the analysis of 13 studies of the last eight years. The reviewed literature returned prevalence ranges between 67.8% and 87.7% according to the STOPP criteria, according to START criteria prevalence ranged from 39.5% to 99.7%. The main factors associated with the presence of inappropriate prescriptions were age, comorbidities, and polypharmacy. These data highlight that, although the STOPP/START criteria were initially developed for community-dwelling older adults, its use in nursing homes may be a starting point to help detect more efficiently inappropriate prescriptions in institutionalized patients. We hope that this review will help to draw attention to the need for medication monitoring systems in this vulnerable population. [ABSTRACT FROM AUTHOR]

Objectives: Aging is associated with an increased prevalence of chronic diseases and multidrug therapy, which increases the risk of drug side effects and changes in quality of life. With the increase of the world’s aging proportion, the quality and safety of prescribing drugs has become a global health concern. This study aims to determine the prevalence of Potentially Inappropriate Medications (PIMs) in the elderly in Qom, Iran according to STOPP (Screening Tool of Older Persons’ Prescriptions) criteria and its association with their Health-Related Quality of Life (HRQOL). Methods & Materials: In this cross-sectional and descriptive-analytical study, participants were 783 older patients hospitalized in internal and surgical wards of selected hospitals affiliated to Qom University of Medical Sciences who were selected using a convenience sampling method. The instruments were a demographic/ health information form, Charlson Comorbidity Index (CCI), STOPP version 2, and the 15 D HRQOL questionnaire. The data were analyzed in SPSS v. 20 software using descriptive statistics and logistic regression analysis. Results: The Mean±SD number of medications used by the elderly was 7.21±3.16, and 79.57% of patients had multidrug use. The CCI score of 29.9% was 4. The prevalence of PIM was 46.10% and the most common category of PIM were Drugs that adversely affect those prone to falls (13.79%), Duplicate Drug Class (12.39%), Central Nervous System and Psychotropics (5.36%). The Mean±SD score of HRQOL was 0.85± 0.12. Logistic regression analysis results showed that HRQOL (95%CI: 0.030-0.307, OR= 0.096), multidrug use (95%CI: 4.780-14.966, OR=8.46), and CCI (95%CI: 1.36-3.17, OR=2.079) had significant association with PIM use by the elderly (P

Background: Higher prevalence of inappropriate medication use among cancer patients increases risk of drug-related problems(DRP) like drug-drug interactions, ADR, and non-adherence. Potentially inappropriate medication (PIM) and Potential Prescription Omission (PPO) were identified using Screening Tool of Older Person's Prescriptions (STOPP) and Screening Tool to Alert Doctors to the Right Treatment (START) criteria. Objectives: The study objective was to optimize prescriptions for the elderly by analyzing the impact of medication review. Methods: An observational study in which PIM and/or PPO were identified and the prescriptions were optimized by a physician. Results: Out of 150 patients, a total of 35 drugs were stopped and 12 drugs were started. Medication omissions were identified in 12 patients (8%). There were no DRPs associated with medication adjustments. Conclusion: Based on a pharmacist-led comprehensive medication review of the elderly, the STOPP and START criteria allow the optimization of prescriptions. [ABSTRACT FROM AUTHOR]

Valentina Buda,1,* Andreea Prelipcean,2,* Minodora Andor,3,* Liana Dehelean,4,* Olivia Dalleur,5 Simona Buda,2 Lavinia Spatar,2 Maria Cristiana Mabda,1 Maria Suciu,1 Corina Danciu,6 Anca Tudor,7 Lucian Petrescu,8,9 Carmen Cristescu1 1Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, “Victor Babeş” University of Medicine and Pharmacy, Timisoara, Romania; 2“Victor Babeş” University of Medicine and Pharmacy, Timisoara, Romania; 3Department of Medical Semiotics, Faculty of Medicine, “Victor Babeş” University of Medicine and Pharmacy, Timisoara, Romania; 4Discipline of Psychiatry, Department of Neurosciences, Faculty of Medicine, “Victor Babeş” University of Medicine and Pharmacy, Timisoara, Romania; 5Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain UCLouvain, Bruxelles, Belgium; 6Department of Pharmacognosy, Faculty of Pharmacy, “Victor Babeş” University of Medicine and Pharmacy, Timisoara, Romania; 7Department of Statistics and Biomedical Informatics, Faculty of Pharmacy, “Victor Babeş” University of Medicine and Pharmacy, Timisoara, Romania; 8Department of Cardiology VI, Faculty of Medicine, “Victor Babeş” University of Medicine and Pharmacy, Timisoara, Romania; 9Cardiovascular Diseases Institute, Timisoara, Romania*These authors contributed equally to this workCorrespondence: Valentina BudaDepartment of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, “Victor Babeş” University of Medicine and Pharmacy, 2 Eftimie Murgu Street, Timisoara 300041, RomaniaTel/Fax +40-256-494-604Email buda.valentina.oana@gmail.comBackground: Rational use of medications and monitoring of prescriptions in elderly patients is important to decrease the number and duration of hospitalizations, emergency medical consultations, mortality, as well as medical costs.Purpose: To identify potentially inappropriate medications (PIMs) and potential prescription omissions (PPOs), and determine their prevalence based on the Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) v2 criteria and Screening Tool to Alert doctors to Right Treatment (START) v2 criteria for patients aged > 65 years.Methods: This cross-sectional study was conducted in two rural counties in Romania based on electronic prescriptions for chronic conditions (EPCCs) issued from 30 days to 90 days by a specialist or general practitioner. Collected EPCCs were evaluated by an interdisciplinary team of specialists based on 26 STOPP v2 criteria and 10 START v2 criteria.Results: PIM prevalence was 25.80% and PPO prevalence was 41.72% for 646 EPCCs. The mean age of patients was 75 years and the mean number of drugs per EPCC was four. The most frequently identified PIMs were treatment duration (6.65%), theophylline administration (5.72%), drug indication (4.64%), cyclo-oxygenase-2 non-steroidal anti-inflammatory drugs (1.39%), and zopiclone prescription (0.77%). Statins (24.76%), beta-blockers (8.04%), and beta-2 agonist/antimuscarinic bronchodilators (5.88%) were the most frequently identified PPOs.Conclusion: PPOs were more prevalent than PIMs for elderly populations living in the two rural counties in Romania we studied. Health practitioners (family physicians, specialists, and pharmacists) should focus on prophylactic and curative considerations when prescribing agents to decrease the morbidity and mortality of elderly rural Romanian patients.Keywords: Romanian elderly, rural zones, chronic prescriptions, STOPP, START

Objectives: Aging is associated with an increased prevalence of chronic diseases and multidrug therapy, which increases the risk of drug side effects and changes in quality of life. With the increase of the world's aging proportion, the quality and safety of prescribing drugs has become a global health concern. This study aims to determine the prevalence of Potentially Inappropriate Medications (PIMs) in the elderly in Qom, Iran according to STOPP (Screening Tool of Older Persons' Prescriptions) criteria and its association with their Health-Related Quality of Life (HRQOL). Methods & Materials: In this cross-sectional and descriptive-analytical study, participants were 783 older patients hospitalized in internal and surgical wards of selected hospitals affiliated to Qom University of Medical Sciences who were selected using a convenience sampling method. The instruments were a demographic/ health information form, Charlson Comorbidity Index (CCI), STOPP version 2, and the 15 D HRQOL questionnaire. The data were analyzed in SPSS v. 20 software using descriptive statistics and logistic regression analysis. Results: The Mean±SD number of medications used by the elderly was 7.21±3.16, and 79.57% of patients had multidrug use. The CCI score of 29.9% was 4. The prevalence of PIM was 46.10% and the most common category of PIM were Drugs that adversely affect those prone to falls (13.79%), Duplicate Drug Class (12.39%), Central Nervous System and Psychotropics (5.36%). The Mean±SD score of HRQOL was 0.85± 0.12. Logistic regression analysis results showed that HRQOL (95%CI: 0.030-0.307, OR= 0.096), multidrug use (95%CI: 4.780-14.966, OR=8.46), and CCI (95%CI: 1.36-3.17, OR=2.079) had significant association with PIM use by the elderly (P<0.001). Conclusion: The use of PIM is a common health problem among the elderly and is associated with HRQOL, multidrug use, and CCI. Nurses should evaluate the elderly's medication regimen to identify PIMs. [ABSTRACT FROM AUTHOR]

Background: Polypharmacy and inappropriate prescribing are risk factors for adverse drug reactions, which commonly cause complications in older people. The STOPP (Screening Tool of Older Persons' Prescriptions)/START (Screening Tool to Alert Doctors to Right Treatment) criteria are screening tools, which aim to improve prescribing in the elderly. Objectives: The aim was to improve prescribing, using the STOPP/START criteria, for patients aged 65 and above, who were admitted to the Clinical Decisions Unit at University Hospital Lewisham. We focused on the most common prescribing errors in clinical decision unit, an emergency medicine department. Methods: We reviewed all patients aged 65 and above admitted to the Clinical Decisions Unit in September. Data was collected from clinical documentation and archived drug charts. This pilot study of 114 patients revealed the most common prescribing errors, of which 8 were STOPP and 11 were START criteria. A plan–do–study–act methodology was implemented over 1 month, involving presentations, emails and posters. Prescribing patterns were then reviewed over 4 weeks in December in 111 patients. Results: Focusing on the 8 STOPP and 11 START criteria, there was a significant reduction in the proportion of patients with at least one STOPP error (17.5% to 9%, p = 0.04). However, the decrease in the percentage of patients with at least one START error was insignificant (24.6% to 20.7%, p = 0.24). Conclusion: By identifying problematic areas of prescribing and using targeted interventions, the proportion of STOPP errors made in clinical decision unit reduced significantly. This study highlights the prevalence of prescription errors in the clinical decision unit and the impact of using screening tools to reduce incorrect prescribing. [ABSTRACT FROM AUTHOR]

Zhuo Ma,1,* Caixia Zhang,1,2,* Xiangli Cui,1 Lihong Liu1 1Pharmacy Department of Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China; 2Pharmacy Department of Civil Aviation General Hospital, Beijing, China *These authors contributed equally to this work Objectives: This study aimed to compare the prevalence of potentially inappropriate medications (PIMs) among Chinese aged patients using the Beers criteria of 2015, the Screening Tool of Older Persons’ Prescriptions (STOPP) of 2014 and the criteria of PIMs for older adults in China (Chinese criteria), and to identify the correlates of the PIMs’ use. Methods: A retrospective, cross-sectional study was conducted among geriatric patients at Beijing Chao-Yang Hospital between January 2018 and March 2018. Three criteria (the Beers criteria of 2015, the STOPP criteria of 2014 and the Chinese criteria) were used to detect PIMs. A multivariate logistic regression analysis was carried out to determine factors associated with the use of PIMs. Leading PIMs for each set of criteria were also listed. The concordance among the three PIM criteria was calculated using kappa tests. Results: Totally, 863 inpatients aged ≥65 years were included. The prevalence of patients receiving at least one PIM was 80.2%, 58.1% and 44.0% according to the Chinese criteria, 2015 Beers criteria and 2014 STOPP criteria, respectively. The Beers and the STOPP criteria indicated a moderate coherence, whereas the Chinese criteria showed poor concordance with the other two criteria. Proton-pump inhibitors in the Beers and STOPP criteria and clopidogrel in the PIM-Chinese accounted for most leading PIMs. The most important factor associated with PIM use by all three sets of criteria was the number of prescribed medications. Conclusion: Data showed a high PIM prevalence among older adults in China, which was associated with the number of prescribed medications. The Chinese criteria had the highest detection rate but a poor concordance with the Beers and STOPP criteria (P

Aim: Evaluate the degree of acceptance of the Pharmaceutical Intervention to potentially inappropriate prescription identified by STOPP/START criteria in geriatric diabetic patients hospitalized at a third-level health institution in Cartagena- Colombia. Materials and methods: A prospective intervention study was carried out on the potentially inadequate prescriptions identified by STOPP/START criteria for a year, in patients with diabetes mellitus. Results: The population was composed of multipathological patients, in which HT, kidney disease were the most prevalent comorbidities. Due to the complexity of this type of patient and the high demand for drugs in the treatment of comorbidities appear potentially inappropriate prescription. Due to the complexity of this type of patient and the high demand for drugs in the treatment of comorbidities, potentially inappropriate threats are prescribed. The degree of acceptance of the interventions was 97.21% by the medical staff. Conclusion: The degree of acceptance of the interventions carried out according to the STOPP/START criteria suggests that these criteria are an important tool to improve pharmacological therapy. [ABSTRACT FROM AUTHOR]

Background Potentially inappropriate medications for older adults are those that offer more risks than benefits for this population. Such medications found in older adults' prescriptions across the world are associated with higher rates of comorbidities and hospitalizations, along with high expenditure on healthcare resources. Objectives To estimate the frequency of older adults using potentially inappropriate medications according to four different criteria, to identify factors associated with the use of such medicines and differences between the tools. Setting A primary healthcare unit linked to a university hospital in Porto Alegre, Brazil. Method This was a cross-sectional study conducted via data collection from the electronic medical records of 390 older adults. The information collected comprised sex, age, chronic diseases diagnosed and medications used. The dependent variable of the study was the use of at least one potentially inappropriate medication, according to the following criteria: Beers, Screening Tool of Older Persons' Prescriptions (STOPP), Brazilian consensus and Anticholinergic Risk Scale (ARS). Main outcome measurement Prevalence of inappropriate medication, differences between the tools and associated factors. Results: The use of at least one potentially inappropriate medication was found in 55.1% of the sample according to the Beers criterion, 51.3% according to the Brazilian consensus, 42.6% according to STOPP and 23.6% according to ARS. It was also seen that 14.9% of the studied population was exposed to a very strong anticholinergic risk. Depending on which tools were used, the agreement observed between the criteria was considered high, moderate, or low. Regarding the four criteria, the use of potentially inappropriate medication is associated with polypharmacy, the diagnosis of three or more chronic diseases and the presence of neuropsychiatric and musculoskeletal diseases. Conclusion Among the older adult population studied, the prevalence of potentially anappropriate medication is high, according to the four different classification criteria used. As a more specific tool, the agreement between Anticholinergic Risk Scale and other criteria was lower, but it can be an important complement to other lists. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess the agreement of several different measures of potentially inappropriate prescribing (PIP) in older people and compare their relationship with patient‐reported outcomes. DESIGN: Prospective cohort study including participants in The Irish Longitudinal Study on Ageing (TILDA). SETTING: Waves 1 and 2 of TILDA, a nationally representative aging cohort study. PARTICIPANTS: A total of 1753 community‐dwelling TILDA participants with linked administrative pharmacy claims data on medications. MEASUREMENTS: Potentially inappropriate medications were assessed using the Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) v1, American Geriatrics Society (AGS) Beers Criteria® 2012, and relevant Assessing Care of Vulnerable Elders (ACOVE) v3 indicators. Potential prescribing omissions were assessed using the Screening Tool to Alert Doctors to the Right Treatment (START) v1 and ACOVE v3 indicators. Their agreement was assessed via κ statistics, and multivariate regression was used to assess relationships with emergency department visits, general practitioner (GP) visits, quality of life, and functional decline (increased assistance needed for activities of daily living). RESULTS: There was slight agreement between STOPP and AGS Beers Criteria® (κ = 0.20) and ACOVE indicators (κ = 0.15), while agreement between AGS Beers Criteria® and ACOVE indicators was fair (κ = 0.31). Agreement was fair between START and ACOVE indicators (κ = 0.34). All measures of inappropriate medications were significantly associated with increased GP visits. Only exposure to two or more START indicators was associated with reduced quality of life (adjusted mean difference = −1.12; 95% confidence interval [CI] = −1.92 to −0.33), and only two or more AGS Beers Criteria® were associated with functional decline (adjusted odds ratio = 2.11; 95% CI = 1.37‐3.28). For omissions, both measures were associated with functional decline, but only ACOVE indicators were associated with increased GP visits. CONCLUSION: Prevalence of PIP and relationships with outcomes can differ substantially between tools with little agreement. Choice of PIP measure for research or practice should be considered in light of the circumstances and requirements in each case. J Am Geriatr Soc 68:526–534, 2020 [ABSTRACT FROM AUTHOR]

Background Polypharmacy has been associated with an increased risk of morbidity and mortality among older adults especially those living in nursing homes. Explicit criteria to evaluate the appropriateness of medications have recently been updated. Objective To estimate and compare the prevalence of potentially inappropriate medications (PIMs) among older adults in nursing homes using screening tool for older people's prescription (STOPP-2) and the 2015 Beers criteria. Setting Nursing care homes in the Klang Valley, Malaysia. Method A cross-sectional survey of medications used among residents living in nursing homes was performed. The 2015 Beers criteria and STOPP-2 criteria were used to evaluate the use of PIMs among this population. These PIMs were subsequently classified using the Pharmaceutical Network Europe classification (PCNE). Main outcome measure Number of PIMs among residents using both criteria. Results A total of 155 residents were recruited into the study. The prevalence of PIMs was 9.7% using the STOPP-2 criteria, 17.6% using the 2015 Beers criteria and 21.3% when both tools were used in combination. The PCNE criteria identified a total of 198 drug related issues, with an average of 1.27 issue per resident. Factors associated with higher risk of having PIM include multiple medication use and history of psychiatric disorder. Conclusion The 2015 Beers criteria was able to identify more PIM's compared to STOPP-2 criteria. The findings also support the expansion of pharmacists' services in nursing homes in Malaysia. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study is to identify and explore risk factors of serious adverse drug events (SADE) and SADE-related admissions in acutely hospitalized multimorbid older adults and assess whether these could have been prevented by adherence to the prescription tools Screening Tool of Older Persons' Prescriptions (STOPP) and The Norwegian General Practice (NORGEP) criteria. Methods: Cross-sectional study of acutely admitted patients to a medical department in a Norwegian regional hospital. Eligible patients were community-dwelling, receiving home care services, and aged 75+, with ≥ 3 chronic diseases. Medications and information regarding the admission were retrieved from the referral letter and medical records, while an expert panel identified SADE using the Common Terminology Criteria for Adverse Events and SADE-related admissions. Results: We included 232 patients. Mean (SD) age was 86 (5.7) years, 137 (59%) were female, 121 (52%) used 5–9 drugs whereas 65 (28%) used ≥ 10. We identified SADEs in 72 (31%) of the patients, and in 49 (68%) of these cases, the SADE was considered to cause the hospital admission. A low body mass index (BMI) and a high Cumulative Illness Rating Scale-Geriatrics (CIRS-G) score were independent risk factors for SADEs. Among the SADEs identified, 32 (44%) and 11 (15%) were preventable by adherence to STOPP and NORGEP, respectively. Conclusions: We found a high prevalence of SADE leading to hospitalization. Risk factors for SADE were high CIRS-G and low BMI. STOPP identified more SADEs than NORGEP, but adherence to the prescription tools could only to a limited degree prevent SADEs in this patient group. [ABSTRACT FROM AUTHOR]

Medication deprescribing is essential to prevent inappropriate medication use in multimorbid patients. However, experience of deprescribing in Danish Subacute Medical Outpatient Clinics (SMOCs) is limited. The objective of our pilot study was to evaluate the feasibility and sustainability of a collaborative deprescribing intervention by a pharmacist and a physician to multimorbid patients in a SMOC. A randomized controlled pilot study was conducted, with phone follow-up at 30 and 365+ days. A senior pharmacist performed a systematic deprescribing intervention using the Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) criteria, the Danish deprescribing list, and patient interviews. A senior physician received the proposed recommendations and decided which should be implemented. The main outcome was the number of patients having ≥1 medication where deprescribing status was sustained 30 days after inclusion. Out of 76 eligible patients, 72 (95%) were included and 67 (93%) completed the study (57% male; mean age 73 years; mean number of 10 prescribed medications). Nineteen patients (56%) in the intervention group and four (12%) in the control group had ≥1 medication where deprescribing status was sustained 30 days after inclusion (p = 0.015). In total, 37 medications were deprescribed in the intervention group and five in the control group. At 365+ days after inclusion, 97% and 100% of the deprescribed medications were sustained in the intervention and control groups, respectively. The three most frequently deprescribed medication groups were analgesics, cardiovascular, and gastrointestinal medications. In conclusion, a collaborative deprescribing intervention for multimorbid patients was feasible and resulted in sustainable deprescribing of medication in a SMOC.

Potentially inappropriate prescription in elderly patients can be evaluated by different methods. The STOPP Criteria and Beers Criteria stand out among the explicit criteria most widely used. Objective: The main objective of this study is to identify the agreement in the detection of potentially inappropriate prescribing between the STOPP criteria and the Beers Criteria, in elderly patients assessed at the time of hospital admission. Method: An observational retrospective study was designed in order to estimate the prevalence of potentially inappropriate prescription in the habitual treatment before admission, and to compare the agreement in detection capability between the 2003 Beers Criteria and the 2009 STOPP Criteria, in >70-yearold patients with an emergency hospital admission. There was also a specific analysis of the prescription of first-generation antihistamines, tricyclic antidepressants, benzodiazepines, and selective serotonin reuptake inhibitors, which are considered drugs with irregular management and potential toxicity. Results: The total prevalence of patients with a potentially inappropriate prescription was 23.8% using the Beers Criteria and 33.3% using the STOPP Criteria. There was a low level of agreement between both questionnaires. First-generation antihistamines (Beers) and pharmacological duplication (STOPP J) were the criteria most frequently found. There were differences in the prevalence of potentially inappropriate prescription in the four pharmacological groups selected; and in all cases, detection by Beers Criteria was superior. Conclusion: There is no agreement between the STOPP Criteria and the Beers Criteria regarding the detection of patients with potentially inappropriate prescribing at the time of hospital admission.

Background: The aims of this study were to generate a comprehensive potentially inappropriate medication (PIM) list applicable for Korean elderly based on the international PIM lists (Beers, Screening Tool for Older Person's Prescriptions, and PRISCUS), and to determine the PIM prevalence rate in the elderly who utilized long-term care services. Methods: We generated a list of drug ingredients included in all the three criteria, and also the current Korean national formulary list. Twenty-six drug ingredients belonging to seven drug classes were finally selected. A two-round Delphi survey consisting of 20 experts was conducted to make a consensus on the PIM criteria applicable to Korean elderly. Individual questions regarding PIM criteria were answered using a 5-point Likert scale. The PIM prevalence rate in elderly was analyzed using the National Health Insurance claims data and the Long-term Care Benefit claims data over a 6-month period (from July 2011 to December 2011). Results: All 26 drug ingredients were determined to be PIMs for Korean elderly. The prevalence rate of PIM in elderly under long-term care was 41.4% (98,158/237,285 individuals). Benzodiazepines were the most prevalent PIM drug class (28.9%), followed by first generation antihistamines (26.9%). The use of nonsteroidal anti-inflammatory drugs and tricyclic antidepressants were 9.3% and 6.4% of total individuals, respectively. Conclusion: The comprehensive PIM list may be helpful for clinical practitioners to optimize drug choices for their elderly patients. A relatively high PIM prevalence in the elderly suggests that efficient strategies should be designed to reduce PIM in elderly populations in long-term care settings.

Introducción: Los ancianos son un grupo de pacientes heterogéneos a los que se les prescribe un número elevado de medicamentos. Esto conlleva a prescripciones potencialmente inapropiadas. Objetivo: Analizar la farmacoterapia del paciente anciano desde la farmacia comunitaria para detectar prescripciones potencialmente inapropiadas (Beers 2012 y STOPP) y prescripciones potencialmente omitidas (START), determinando su prevalencia. Metodología: Estudio descriptivo, observacional en el que se incluyeron pacientes mayores de 65 años de atención primaria que llevaban al menos un tratamiento crónico. Se verificó la idoneidad de la medicación según los criterios Beers 2012 y STOPP & START. Resultados: Se incluyeron 223 pacientes con una edad media de 75 años. En total se prescribieron 1.558 medicamentos, con una media de 7 medicamentos por paciente. El 67 % de los pacientes eran polimedicados. Con Beers 2012 se detectaron 246 prescripciones inapropiadas y el criterio que más se repitió fue el de benzodiazepinas de acción corta, intermedia y larga (36 %). Con STOPP se detectaron 146 prescripciones inapropiadas. El criterio más frecuente fue IBP a dosis plenas durante más de 8 semanas (14 %). Con START se detectaron 103 prescripciones potencialmente omitidas, siendo antiagregantes plaquetarios en diabetes mellitus la más frecuente (11,6 %). Conclusiones: Los criterios Beers 2012 y STOPP-START, suponen una herramienta de utilidad en la detección de los posibles problemas relacionados con los medicamentos en una farmacia comunitaria. En ningún caso suponen una prohibición en la utilización de dichos medicamentos, puesto que su prescripción dependerá de las características del paciente en concreto y del juicio clínico del médico prescriptor.

Objective The goal of this pharmacist-led study was to utilize two validated instruments, Beers Criteria and Screening Tool of Older Persons' Potentially Inappropriate Prescriptions ( STOPP), to assess potentially inappropriate prescribing ( PIP) in older patients infected with the human immunodeficiency virus ( HIV) and evaluate pharmacist interventions. Design Prospective randomized interventional trial. Setting Large urban clinic providing interdisciplinary primary and HIV care for ~2700 HIV-positive publicly insured patients. Data Source A computerized electronic record search was conducted for all patients who met the two search criteria: 50 years and older, and a primary care appointment within the last 12 months. Patients After identification of 857 patients meeting the search criteria, 324 patients were randomly selected and contacted, resulting in 248 patients assessed. Measurements and Main Results Patients had a mean age of 58 years, 71% male, 44% white, and a mean CD4 count of 536 cells/mm3. Common comorbidities included hypertension (56%), depression (52%), asthma/chronic obstructive pulmonary disease (48%), dyslipidemia (39%), coronary artery disease (27%), and diabetes (22%). Patients sampled were prescribed a mean of 11.6 ± 5.7 concomitant medications (excluding antiretrovirals) with 35% receiving at least 16 medications. PIP was identified in 54% and 63% of patients using the STOPP and Beers Criteria, respectively. Twenty-five contraindicated drug interactions were identified in 20 patients. After the pharmacist visit, at least 69% of patients had at least one medication discontinued with almost 10% having six or more medications discontinued. More than 40% of patients had at least one Beers or STOPP criteria that required immediate correction by the pharmacist. Conclusions Results suggest that targeting individuals with 11 or more chronic medications would have the highest yield and greatest impact. Pharmacist-led review of medication prescribing using Beers and STOPP criteria revealed a large number of PIP, many amenable to immediate clinical pharmacist intervention. [ABSTRACT FROM AUTHOR]

Aims This study aims to determine if potentially inappropriate prescribing (PIP) is associated with increased healthcare utilization, functional decline and reduced quality of life (QoL) in a community-dwelling older cohort. Method This prospective cohort study included participants aged ≥65 years from The Irish Longitudinal Study on Ageing (TILDA) with linked administrative pharmacy claims data who were followed up after 2 years. PIP was defined by the Screening Tool for Older Persons Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START). The association with number of emergency department (ED) visits and GP visits reported over 12 months was analyzed using multivariate negative binomial regression adjusting for confounders. Marginal structural models investigated the presence of time-dependent confounding. Results Of participants followed up ( n = 1753), PIP was detected in 57% by STOPP and 41.8% by START, 21.7% reported an ED visit and 96.1% visited a GP (median 4, IQR 2.5-6). Those with any STOPP criterion had higher rates of ED visits (adjusted incident rate ratio (IRR) 1.30, 95% confidence interval (CI) 1.02, 1.66) and GP visits (IRR 1.15, 95%CI 1.06, 1.24). Patients with two or more START criteria had significantly more ED visits (IRR 1.45, 95%CI 1.03, 2.04) and GP visits (IRR 1.13, 95%CI 1.01, 1.27) than people with no criteria. Adjusting for time-dependent confounding did not affect the findings. Conclusions Both STOPP and START were independently associated with increased healthcare utilization and START was also related to functional decline and QoL. Optimizing prescribing to reduce PIP may provide an improvement in patient outcomes. [ABSTRACT FROM AUTHOR]

What is known and objective: STOPP/START are explicit screening tools that identify potentially inappropriate prescribing in older adults. Our objective was to update our 2013 systematic review that showed limited evidence of impact, using new evidence from randomized controlled trials (RCTs) assessing clinical, humanistic and economic outcomes in older adults. Methods: Weperformeda search of PubMed,EMBASE,CINAHL, Web of Science and grey literature for RCTs published in English since the previous review through June 2014. The Cochrane Risk of Bias Tool was used. We performed a meta-analysis on the effect of STOPP on potentially inappropriate medication (PIM) rates and a narrative synthesis on other outcomes. Results and discussion: Four RCTs (n = 1925 adults) from four countries were included, reporting both acute (n = 2) and long-term care (n = 2) patients. Studies differed in implementation. Two studies were judged to have low risk, and two to have moderate-to-high risk of bias in key domains. Meta-analysis found that the STOPP criteria reduced PIM rates in all four studies, but study heterogeneity (I² = 86.7%) prevented the calculation of a meaningful statistical summary. We found evidence that use of the criteria reduces falls, delirium episodes, hospital length-of-stay, care visits (primary and emergency) and medication costs, but no evidence of improvements in quality of life or mortality. What is new and conclusion: STOPP/START may be effective in improving prescribing quality, clinical, humanistic and economic outcomes. Additional research investigating these tools is needed, especially in frail elderly and community-living patients receiving primary care. [ABSTRACT FROM AUTHOR]

Summary Background The aims of this study were to generate a comprehensive potentially inappropriate medication (PIM) list applicable for Korean elderly based on the international PIM lists (Beers, Screening Tool for Older Person's Prescriptions, and PRISCUS), and to determine the PIM prevalence rate in the elderly who utilized long-term care services. Methods We generated a list of drug ingredients included in all the three criteria, and also the current Korean national formulary list. Twenty-six drug ingredients belonging to seven drug classes were finally selected. A two-round Delphi survey consisting of 20 experts was conducted to make a consensus on the PIM criteria applicable to Korean elderly. Individual questions regarding PIM criteria were answered using a 5-point Likert scale. The PIM prevalence rate in elderly was analyzed using the National Health Insurance claims data and the Long-term Care Benefit claims data over a 6-month period (from July 2011 to December 2011). Results All 26 drug ingredients were determined to be PIMs for Korean elderly. The prevalence rate of PIM in elderly under long-term care was 41.4% (98,158/237,285 individuals). Benzodiazepines were the most prevalent PIM drug class (28.9%), followed by first generation antihistamines (26.9%). The use of nonsteroidal anti-inflammatory drugs and tricyclic antidepressants were 9.3% and 6.4% of total individuals, respectively. Conclusion The comprehensive PIM list may be helpful for clinical practitioners to optimize drug choices for their elderly patients. A relatively high PIM prevalence in the elderly suggests that efficient strategies should be designed to reduce PIM in elderly populations in long-term care settings. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Explicit criteria for evaluating the appropriateness of medication use among the elderly have been extensively employed in several countries. The aim of the current study was to assess and characterize the prevalence of potentially inappropriate medications ( PIMs) according to the Screening Tool of Older People's Prescriptions ( STOPP) criteria and compare these data with the 2012 Beers criteria. Methods A prospective survey of the medications used by elderly patients was performed. A total of 142 participants were randomly selected via systematic sampling. The Beers and STOPP criteria were applied to evaluate the use of PIMs among the sample. All of the medications included in these criteria were assessed for their availability in Brazil. The prevalence of PIMs was chosen as an occurrence measure and compared among the exposure group using the prevalence ratio ( PR) as a measure of association. Results The prevalence of PIM use in the sample was 33.8% according to the STOPP criteria and 51.8% using the 2012 Beers criteria. The most prevalent PIMs according to the Beers criteria were short-acting nifedipine (17.4%) and glyburide (11.9%); according to the STOPP criteria, they were acetylsalicylic acid (32.9%), clonazepam (10.1%) and diclofenac (6.3%). The use of four or more drugs (polypharmacy) was associated with a higher prevalence of PIM use ( PR = 3.11, 95% CIs = 1.65-5.85). Conclusions The 2012 Beers criteria identified more PIMs than the STOPP criteria. This difference highlights the need to develop national criteria. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to compare the prevalence of potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs) using several screening tools in an Irish community-dwelling older cohort, to assess if the prevalence changes over time and to determine factors associated with any change. Methods: This is a prospective cohort study of participants aged ≥65 years in The Irish Longitudinal Study on Ageing (TILDA) with linked pharmacy claims data ( n = 2051). PIM and PPO prevalence was measured in the year preceding participants' TILDA baseline interviews and in the year preceding their follow-up interviews using the Screening Tool for Older Persons' Prescriptions (STOPP), Beers criteria (2012), Assessing Care of Vulnerable Elders (ACOVE) indicators and the Screening Tool to Alert doctors to Right Treatment (START). Generalised estimating equations were used to determine factors associated with change in prevalence over time. Results: Depending on the screening tool used, between 19.8 % (ACOVE indicators) and 52.7 % (STOPP) of participants received a PIM at baseline, and PPO prevalence ranged from 38.2 % (START) to 44.8 % (ACOVE indicators), while 36.7 % of participants had both a PIM and PPO. Common criteria were aspirin for primary prevention (19.6 %) and omission of calcium/vitamin D in osteoporosis (14.7 %). Prevalence of PIMs and PPOs increased at follow-up (PIMs range 22-56.1 %, PPOs range 40.5-49.3 %), and this was associated with patient age, female sex, and numbers of medicines and chronic conditions. Conclusions: Sub-optimal prescribing is common in older patients. Ongoing prescribing review to optimise care is important, particularly as patients get older, receive more medicines or develop more illnesses. [ABSTRACT FROM AUTHOR]

Purpose: We sought to estimate the prevalence of potentially inappropriate prescriptions (PIP) and potential prescribing omissions (PPOs) using a subset of the STOPP/START criteria in a population based sample of Irish adults aged ≥65 years using data from The Irish Longitu Dinal Study on Ageing (TILDA). Methods: A subset of 26 PIP indicators and 10 PPO indicators from the STOPP/START criteria were applied to the TILDA dataset. PIP/PPO prevalence according to individual STOPP/START criteria and the overall prevalence of PIP/PPO were estimated. The relationship between PIP and PPOs and polypharmacy, age, gender and multimorbidity was examined using logistic regression. Results: The overall prevalence of PIP in the study population ( n = 3,454) was 14.6 %. The most common examples of PIP identified were NSAID with moderate-severe hypertension (200 participants; 5.8 %) and aspirin with no history of coronary, cerebral, or peripheral vascular symptoms or occlusive event (112 participants; 3.2 %). The overall prevalence of PPOs was 30 % ( n = 1,035). The most frequent PPO was antihypertensive therapy where systolic blood pressure consistently >160 mmHg ( n = 341, 9.9 %), There was a significant association between PIP and PPO and polypharmacy when adjusting for age, sex and multimorbidity (adjusted OR 2.62, 95 % CI 2.05-3.33 for PIP and adjusted OR 1.46, 95 % CI 1.23-1.75 for prescribing omissions). Conclusion: Our findings indicate prescribing omissions are twice as prevalent as PIP in the elderly using a subset of the STOPP/START criteria as an explicit process measure of potentially inappropriate prescribing and prescribing omissions. Polypharmacy was independently associated with both PPO and PIP. Application of such screening tools to prescribing decisions may reduce unnecessary medication, related adverse events, healthcare utilisation and cost. [ABSTRACT FROM AUTHOR]

Background: Health care policy-makers look for prescribing indicators at the population level to evaluate the performance of prescribers, improve quality and control drug costs. The aim of this research was to; (i) estimate the level of variation in potentially inappropriate prescribing (PIP) across prescribers in the national Irish older population using the STOPP criteria; (ii) estimate how reliably the criteria could distinguish between prescribers in terms of their proportion of PIP and; (iii) examine how PIP varies between prescribers and by patient and prescriber characteristics in a multilevel regression model. Methods: 1,938 general practitioners (GPs) with 338,375 registered patients’ ≥70 years were extracted from the Health Service Executive Primary Care Reimbursement Service (HSE-PCRS) pharmacy claims database. HSE-PCRS prescriptions are WHO ATC coded. Demographic data for claimants’ and prescribers’ are available. Thirty STOPP indicators were applied to prescription claims in 2007. Multilevel logistic regression examined how PIP varied between prescribers and by individual patient and prescriber level variables. Results: The unadjusted variation in PIP between prescribers was considerable (median 35%, IQR 30-40%). The STOPP criteria were reliable measures of PIP (average >0.8 reliability). The multilevel regression models found that only the patient level variable, number of different repeat drug classes was strongly associated with PIP (>2 drugs v none; adjusted OR, 4.0; 95% CI 3.7, 4.3). After adjustment for patient level variables the proportion of PIP varied fourfold (0.5 to 2 times the expected proportion) between prescribers but the majority of this variation was not significant. Conclusion: PIP is of concern for all prescribers. Interventions aimed at enhancing appropriateness of prescribing should target patients taking multiple medications. [ABSTRACT FROM AUTHOR]

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Aims This study aimed to determine the association between potentially inappropriate prescribing ( PIP) and health related outcomes [adverse drug events ( ADEs), health related quality of life ( HRQOL) and hospital accident and emergency ( A&E) visits] in older community dwelling patients. Methods A retrospective cohort study of 931 community dwelling patients aged ≥70 years in 15 general practices in Ireland in 2010. PIP was defined by the Screening Tool of Older Person's Prescriptions ( STOPP). ADEs were measured by patient self-report and medical record for the previous 6 months and reviewed by two independent clinicians. HRQOL was measured by the EQ- 5D. A&E visits were measured by patients' medical records and self-report. Multilevel logistic, linear and Poisson regression examined how ADEs, HRQOL and A&E visits varied by PIP after adjusting for patient and practice level covariates: socioeconomic status, co-morbidity, number of drug classes and adherence. Results The overall prevalence of PIP was 42% ( n = 377). Patients with ≥2 PIP indicators were twice as likely to have an ADE (adjusted OR 2.21; 95% CI 1.02, 4.83, P < 0.05), have a significantly lower mean HRQOL utility (adjusted coefficient −0.09, SE 0.02, P < 0.001) and nearly a two-fold increased risk in the expected rate of A&E visits (adjusted IRR 1.85; 95% CI 1.32, 2.58, P < 0.001). The number of drug classes and adherence were also significantly associated with these same adverse health outcomes. Conclusions Reducing PIP in primary care may help lower the burden of ADEs, its associated health care use and costs and enhance quality of life in older patients. [ABSTRACT FROM AUTHOR]

Background The ageing of the population has become a concern all over the world, including Macao. In general, older people are more prone to adverse drug events which can result from potentially inappropriate medication (PIM) use and drug-drug interactions (DDIs). Objective This study was designed to evaluate the prevalence of PIM use and DDIs among elderly nursing home residents in Macao, and to find out the factors associated with these drug-related problems. Setting This study was conducted in the largest nursing home in Macao, with a bed capacity of 168. Method All data of this cross-sectional study were collected from medical charts and medication administration records. PIM use was determined by the screening tool of older person's prescription (STOPP) criteria and potential DDIs were detected using the preset criteria of two compendia, Drug-Reax and Lexi-Interact. Multivariate logistic regression analysis was performed to identify the independent factors associated with each drug-related problem. Main outcome measures The proportions of elderly nursing home residents who regularly used PIMs and who were exposed to DDIs. Results A total of 114 elderly residents were eligible for PIM analysis. They consumed an average of 6.9 ± 3.1 different medications. About 46.5 % of them regularly used one or more PIMs. The prevalence of DDIs was 37.8 % among the 111 elderly residents who consumed at least two different medications. An increased number of drugs used was identified as the independent factor associated with PIM use and DDIs ( p < 0.05). However, the use of STOPP-related PIMs did not appear to raise the likelihood of DDIs among the study population. Conclusion Both PIM use and DDIs are common among elderly nursing home residents in Macao. Further studies should be conducted to evaluate the clinical outcomes of pharmacist-led interventions for elderly residents in the local nursing home setting. [ABSTRACT FROM AUTHOR]

Abstract: The C-terminal soluble domain of stomatin operon partner protein (STOPP) of the hyperthermophilic archaeon Pyrococcus horikoshii has an oligonucleotide binding-fold (OB-fold). STOPP lacks the conserved surface residues necessary for binding to DNA/RNA. A tryptophan (W) residue is conserved instead at the molecular surface. Solvent-accessible W residues are often found at interfaces of protein–protein complexes, which suggested the possibility of self-assembling of STOPP. Protein–protein interactions among the C-terminal soluble domains of STOPP PH1510 (1510-C) were then analyzed by chemical linking and blue native polyacrylamide gel electrophoresis (BN-PAGE) methods. These results suggest that the soluble domains of STOPP could assemble into homo-oligomers. Since hexameric subcomplex I from archaeal proteasome consists of coiled-coil segments and OB-fold domains, molecular modeling of 1510-C was performed using hexameric subcomplex I as a template. Although 1510-C is a comparatively small polypeptide consisting of approximately 60 residues, numerous salt bridges and hydrophobic interactions were observed in the predicted hexamer of 1510-C, suggesting the stability of the homo-oligomeric structure. This oligomeric property of STOPP may be favorable for triplicate proteolysis of the trimer of prokaryotic stomatin. [Copyright &y& Elsevier]

Purpose: We sought to estimate the prevalence of potentially inappropriate prescribing (PIP) in the Northern Ireland (NI) population aged ≥70 years, to investigate factors associated with PIP and to calculate total gross cost of PIP. Methods: A retrospective cross-sectional population study was carried out in those aged ≥70 years in 2009/2010 who were in primary care in NI. Data were extracted from the Enhanced Prescribing Database, which provides details of prescribed and dispensed medications for each individual registered with a general practitioner. Twenty-eight PIP indicators from the Screening Tool of Older Persons potentially inappropriate Prescriptions (STOPP) criteria were applied to these data. PIP prevalence according to individual STOPP criteria and the overall prevalence of PIP were estimated. The relationship between PIP and polypharmacy, age and gender was examined using logistic regression. Gross cost of PIP was ascertained. Results: The overall prevalence of PIP in the study population ( n = 166,108) was 34 %. The most common examples of PIP identified were proton pump inhibitors at maximum therapeutic dose for >8 weeks (17,931 patients, 11 %), non-steroidal anti-inflammatory drugs >3 months (14,545 patients, 9 %) and long-term long-acting benzodiazepines (10,147 patients, 6 %). PIP was strongly associated with polypharmacy, with those receiving seven different medications being fivefold more likely to be exposed to PIP than those on zero to three medications (odds ratio 5.04, 95 % confidence interval 4.84-5.25) The gross cost of PIP was estimated to be €6,098,419 Conclusions: Consistent with other research, the prevalence of PIP was high among the study cohort, increased with polypharmacy and was associated with significant cost. [ABSTRACT FROM AUTHOR]

Introduction: STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions) is a new, systems-defined medicine review tool. We compared the performance of STOPP to that of established Beers' criteria in detecting potentially inappropriate medicines (PIMs) and related adverse drug events (ADEs) in older patients presenting for hospital admission. Methods: we prospectively studied 715 consecutive acute admissions to a university teaching hospital. Diagnoses, reason for admission and concurrent medications were recorded. STOPP and Beers' criteria were applied. PIMs with clear causal connection or contribution to the principal reason for admission were determined. Results: median patient age (interquartile range) was 77 (72-82) years. Median number of prescription medicines was 6 (range 0-21). STOPP identified 336 PIMs affecting 247 patients (35%), of whom one-third (n = 82) presented with an associated ADE. Beers' criteria identified 226 PIMs affecting 177 patients (25%), of whom 43 presented with an associated ADE. STOPP-related PIMs contributed to 11.5% of all admissions. Beers' criteria-related PIMs contributed to significantly fewer admissions (6%). Conclusion: STOPP criteria identified a significantly higher proportion of patients requiring hospitalisation as a result of PIM-related adverse events than Beers' criteria. This finding has significant implications for hospital geriatric practice. [ABSTRACT FROM AUTHOR]

Medication deprescribing is essential to prevent inappropriate medication use in multimorbid patients. However, experience of deprescribing in Danish Subacute Medical Outpatient Clinics (SMOCs) is limited. The objective of our pilot study was to evaluate the feasibility and sustainability of a collaborative deprescribing intervention by a pharmacist and a physician to multimorbid patients in a SMOC. A randomized controlled pilot study was conducted, with phone follow-up at 30 and 365+ days. A senior pharmacist performed a systematic deprescribing intervention using the Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria, the Danish deprescribing list, and patient interviews. A senior physician received the proposed recommendations and decided which should be implemented. The main outcome was the number of patients having ≥1 medication where deprescribing status was sustained 30 days after inclusion. Out of 76 eligible patients, 72 (95%) were included and 67 (93%) completed the study (57% male; mean age 73 years; mean number of 10 prescribed medications). Nineteen patients (56%) in the intervention group and four (12%) in the control group had ≥1 medication where deprescribing status was sustained 30 days after inclusion (p = 0.015). In total, 37 medications were deprescribed in the intervention group and five in the control group. At 365+ days after inclusion, 97% and 100% of the deprescribed medications were sustained in the intervention and control groups, respectively. The three most frequently deprescribed medication groups were analgesics, cardiovascular, and gastrointestinal medications. In conclusion, a collaborative deprescribing intervention for multimorbid patients was feasible and resulted in sustainable deprescribing of medication in a SMOC. [ABSTRACT FROM AUTHOR]