Application of the STOPP/ START criteria in the survey of medication use in elderly patients with renal failure

Abstract

Introduction. The risk of inappropriate prescribing and inadequate drug use in the elderly population is growing with ageing associated physiological changes and polypharmacy due to increased number of chronic diseases. In order to optimize the therapy, numerous criteria have been developed which can help pharmacists and physicians to implement rational pharmacotherapy. The objectives of the study were to survey the practice of medication use in patients older than 65 years with different stages of renal failure and to identify potentially inappropriate prescribing, as well as to justify the role of pharmacists in pharmacotherapy optimization. Material and methods. This retrospective study included 100 patients with average age of 72.30±5.00 years. Demographic, clinical and pharmacotherapy data were collected from hospital discharge summary after one day hospital examination at the Clinic of Nephrology of Clinical Center Niš, Serbia. Potentially inadequate drugs were identified by STOPP criteria (Screening Tool of Older Persons’ Prescriptions), while START criteria (Screening Tool to Alert doctors to Right Treatment) pointed out the lack of potentially helpful drugs in therapy. Results. 63 STOPP and 60 START criteria were identified. The most common STOPP criteria were the use of benzodiazepines (14%) and duplication of therapy (11%). The greatest influence on the occurrence of STOPP criteria was the total number of medications in therapy. START criteria identified the lack of statins in therapy in 19% of patients with cardiovascular disease and in 13% with diabetes mellitus type 2. The occurrence of START criteria was mostly influenced by the number of comorbidities. Conclusions. The presence of potentially inadequate prescribed and the lack of potentially useful drugs in the complex pharmacotherapy of elderly patients is the reason for including pharmacists in a team which creates optimal pharmacotherapy for elderly.

Keywords

• geriatric population
• stopp/start criteria
• rational pharmacotherapy
• pharmacists