STOPP/START criteria for potentially inappropriate prescribing in older people: version 3

doi:10.1007/s41999-023-00777-y

. 2023 Aug;14(4):625-632.

doi: 10.1007/s41999-023-00777-y. Epub 2023 May 31.

STOPP/START criteria for potentially inappropriate prescribing in older people: version 3

Affiliations

¹ Department of Medicine (Geriatric Medicine), School of Medicine, University College Cork, Cork, Ireland. denis.omahony@ucc.ie.
² Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland. denis.omahony@ucc.ie.
³ Geriatria, Accettazione Geriatrica e Centro di Ricerca Per l'invecchiamento, IRCCS INRCA, Ancona, Italy.
⁴ Department of Geriatric Medicine, Parc de Salut Mar, Barcelona, Spain.
⁵ Institute for Geriatric Research, University of Ulm Geriatric Center, Alb-Donau, Ulm, Germany.
⁶ Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, 59000, Lille, France.
⁷ Fondazione Policlinico Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy.
⁸ Landspitali University Hospital, Reykjavik, Iceland.
⁹ Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain.
¹⁰ Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (EPHOR), University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
¹¹ Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Istanbul, Turkey.
¹² Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
¹³ Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.
¹⁴ Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland.

PMID: 37256475
PMCID: PMC10447584
DOI: 10.1007/s41999-023-00777-y

STOPP/START criteria for potentially inappropriate prescribing in older people: version 3

Denis O'Mahony et al. Eur Geriatr Med. 2023 Aug.

. 2023 Aug;14(4):625-632.

doi: 10.1007/s41999-023-00777-y. Epub 2023 May 31.

Authors

Affiliations

¹ Department of Medicine (Geriatric Medicine), School of Medicine, University College Cork, Cork, Ireland. denis.omahony@ucc.ie.
² Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland. denis.omahony@ucc.ie.
³ Geriatria, Accettazione Geriatrica e Centro di Ricerca Per l'invecchiamento, IRCCS INRCA, Ancona, Italy.
⁴ Department of Geriatric Medicine, Parc de Salut Mar, Barcelona, Spain.
⁵ Institute for Geriatric Research, University of Ulm Geriatric Center, Alb-Donau, Ulm, Germany.
⁶ Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, 59000, Lille, France.
⁷ Fondazione Policlinico Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy.
⁸ Landspitali University Hospital, Reykjavik, Iceland.
⁹ Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain.
¹⁰ Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (EPHOR), University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
¹¹ Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Istanbul, Turkey.
¹² Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
¹³ Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.
¹⁴ Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland.

PMID: 37256475
PMCID: PMC10447584
DOI: 10.1007/s41999-023-00777-y

Erratum in

Correction: STOPP/START criteria for potentially inappropriate prescribing in older people: version 3.
O'Mahony D, Cherubini A, Guiteras AR, Denkinger M, Beuscart JB, Onder G, Gudmundsson A, Cruz-Jentoft AJ, Knol W, Bahat G, van der Velde N, Petrovic M, Curtin D. O'Mahony D, et al. Eur Geriatr Med. 2023 Aug;14(4):633. doi: 10.1007/s41999-023-00812-y. Eur Geriatr Med. 2023. PMID: 37326916 Free PMC article. No abstract available.

Abstract

Purpose: STOPP/START is a physiological systems-based explicit set of criteria that attempts to define the clinically important prescribing problems relating to potentially inappropriate medications (PIMs-STOPP criteria) and potential prescribing omissions (PPOs-START criteria). The previous two versions of STOPP/START criteria were published in 2008 and 2015. The present study describes the revised and updated third version of the criteria.

Methods: A detailed system-by-system review of the published literature from April 2014 to March 2022 was undertaken with the aim of including clinically important new explicit PIM and PPO criteria and removing any criteria considered to be no longer correct or outdated. A panel of 11 academic physicians with recognized expertise in geriatric pharmacotherapy from 8 European countries participated in a Delphi panel with the task of validating the draft criteria. The panel was presented with the draft new criteria using the SurveyMonkey® on-line platform in which panelists were asked to indicate their level of agreement on a five-point Likert scale.

Results: Two hundred and four evidence-based draft criteria (one hundred and forty-five STOPP criteria, fifty-nine START criteria) were presented to panelists for assessment using the Delphi validation method. Over the course of four rounds of Delphi validation, the panel achieved consensus on 133 STOPP criteria and 57 START criteria, i.e., 190 STOPP/START criteria in total representing a 66.7% increase in the number of criteria compared to STOPP/START version 2 published in 2015.

Conclusion: A fully revised and updated version of STOPP/START criteria has been validated by a European expert panel using the Delphi consensus process.

Keywords: Adverse drug events; Medication review; Multimorbidity; Older people; Polypharmacy; STOPP/START criteria.

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Conflict of interest statement

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Figures

**Fig. 1**
Flow diagram depicting Delphi validation process for validation of STOPP/START version 3 criteria

See this image and copyright information in PMC

Comment in

STOPP/START version 3: even better with age.
Rochon PA, Stall NM, Reppas-Rindlisbacher C, Gurwitz JH. Rochon PA, et al. Eur Geriatr Med. 2023 Aug;14(4):635-637. doi: 10.1007/s41999-023-00784-z. Eur Geriatr Med. 2023. PMID: 37256474 Free PMC article. No abstract available.
STOPP/START version 3: looks great, fits well, but itches.
Hilmer SN. Hilmer SN. Eur Geriatr Med. 2023 Aug;14(4):639-641. doi: 10.1007/s41999-023-00828-4. Eur Geriatr Med. 2023. PMID: 37421573 No abstract available.
STOPP/START version 3: overhauled resources to support older people. What will we do next?
Kojima T, Akishita M. Kojima T, et al. Eur Geriatr Med. 2023 Aug;14(4):643-644. doi: 10.1007/s41999-023-00832-8. Eur Geriatr Med. 2023. PMID: 37477805 No abstract available.
Clinical appraisal of STOPP/START version 3 criteria.
Boland B, Marien S, Sibille FX, Locke S, Mouzon A, Spinewine A, Dalleur O. Boland B, et al. Eur Geriatr Med. 2023 Oct;14(5):1149-1150. doi: 10.1007/s41999-023-00839-1. Epub 2023 Jul 27. Eur Geriatr Med. 2023. PMID: 37498508 No abstract available.
Authors' response to points raised by Boland et al. regarding STOPP/START version 3 criteria.
O'Mahony D, Cherubini A, Guiteras AR, Denkinger M, Beuscart JB, Onder G, Gudmundsson A, Cruz-Jentoft AJ, Knol W, Bahat G, van der Velde N, Petrovic M, Curtin D. O'Mahony D, et al. Eur Geriatr Med. 2023 Oct;14(5):1151-1154. doi: 10.1007/s41999-023-00875-x. Epub 2023 Oct 11. Eur Geriatr Med. 2023. PMID: 37819545 No abstract available.

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Discrepancies in Electronic Medical Prescriptions Found in a Hospital Emergency Department: A Prospective Observational Study.
García González D, Teixeira-da-Silva P, Salvador Sánchez JJ, Sánchez Serrano JÁ, Calvo MV, Martín-Suárez A. García González D, et al. Pharmaceuticals (Basel). 2024 Apr 3;17(4):460. doi: 10.3390/ph17040460. Pharmaceuticals (Basel). 2024. PMID: 38675420 Free PMC article.
Development of explicit definitions of potentially inappropriate prescriptions for antidiabetic drugs in patients with type 2 diabetes: A multidisciplinary qualitative study.
Gerard E, Quindroit P, Calafiore M, Baran J, Gautier S, Genay S, Decaudin B, Lemaitre M, Vambergue A, Beuscart JB. Gerard E, et al. PLoS One. 2024 Sep 27;19(9):e0309290. doi: 10.1371/journal.pone.0309290. eCollection 2024. PLoS One. 2024. PMID: 39331645 Free PMC article.
Authors' response to points raised by Boland et al. regarding STOPP/START version 3 criteria.
O'Mahony D, Cherubini A, Guiteras AR, Denkinger M, Beuscart JB, Onder G, Gudmundsson A, Cruz-Jentoft AJ, Knol W, Bahat G, van der Velde N, Petrovic M, Curtin D. O'Mahony D, et al. Eur Geriatr Med. 2023 Oct;14(5):1151-1154. doi: 10.1007/s41999-023-00875-x. Epub 2023 Oct 11. Eur Geriatr Med. 2023. PMID: 37819545 No abstract available.
Prevalence and Associated Predictors of Inappropriate and Omitted Medications Prescribing in Older Patients with Advanced Cancer: A Cross-Sectional Study.
Al-Azayzih A, Bani-Ahmad E, Jarab AS, Kharaba Z, Al-Kubaisi K. Al-Azayzih A, et al. Clin Interv Aging. 2023 Oct 2;18:1653-1661. doi: 10.2147/CIA.S430208. eCollection 2023. Clin Interv Aging. 2023. PMID: 37810955 Free PMC article.
STOPP/START version 3: clinical pharmacists are raising concerns.
Massé O, Flamand Villeneuve J, Lahaie A, Marcoux C, Hill J, Papillon-Ferland L, Desforges K. Massé O, et al. Eur Geriatr Med. 2024 Apr;15(2):589-591. doi: 10.1007/s41999-024-00961-8. Epub 2024 Feb 28. Eur Geriatr Med. 2024. PMID: 38416401 No abstract available.

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References

1. Griese-Mammen N, Hersberger KE, Messerli M, Leikola S, Horvat N, van Mil JWF, Kos M. PCNE definition of medication review: reaching agreement. Int J Clin Pharm. 2018;40(5):1199–1208. doi: 10.1007/s11096-018-0696-7. - DOI - PubMed
1. Beers MH, Ouslander JG, Rollingher I, Reuben DB, Brooks J, Beck JC. Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine. Arch Intern Med. 1991;151(9):1825–1832. doi: 10.1001/archinte.1991.00400090107019. - DOI - PubMed
1. Gallagher P, Ryan C, Byrne S, Kennedy J, O'Mahony D. STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther. 2008;46(2):72–83. doi: 10.5414/CPP46072. - DOI - PubMed
1. 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;44(2):213–218. doi: 10.1093/ageing/afu145. - DOI - PMC - PubMed
1. https://www.nice.org.uk/guidance/ng5 (accessed Sep 12, 2022)

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[1] Griese-Mammen N, Hersberger KE, Messerli M, Leikola S, Horvat N, van Mil JWF, Kos M. PCNE definition of medication review: reaching agreement. Int J Clin Pharm. 2018;40(5):1199–1208. doi: 10.1007/s11096-018-0696-7. - DOI - PubMed

[2] Griese-Mammen N, Hersberger KE, Messerli M, Leikola S, Horvat N, van Mil JWF, Kos M. PCNE definition of medication review: reaching agreement. Int J Clin Pharm. 2018;40(5):1199–1208. doi: 10.1007/s11096-018-0696-7. - DOI - PubMed

[3] Beers MH, Ouslander JG, Rollingher I, Reuben DB, Brooks J, Beck JC. Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine. Arch Intern Med. 1991;151(9):1825–1832. doi: 10.1001/archinte.1991.00400090107019. - DOI - PubMed

[4] Beers MH, Ouslander JG, Rollingher I, Reuben DB, Brooks J, Beck JC. Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine. Arch Intern Med. 1991;151(9):1825–1832. doi: 10.1001/archinte.1991.00400090107019. - DOI - PubMed

[5] Gallagher P, Ryan C, Byrne S, Kennedy J, O'Mahony D. STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther. 2008;46(2):72–83. doi: 10.5414/CPP46072. - DOI - PubMed

[6] Gallagher P, Ryan C, Byrne S, Kennedy J, O'Mahony D. STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther. 2008;46(2):72–83. doi: 10.5414/CPP46072. - DOI - PubMed

[7] 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;44(2):213–218. doi: 10.1093/ageing/afu145. - DOI - PMC - PubMed

[8] 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;44(2):213–218. doi: 10.1093/ageing/afu145. - DOI - PMC - PubMed

[9] https://www.nice.org.uk/guidance/ng5 (accessed Sep 12, 2022)

[10] https://www.nice.org.uk/guidance/ng5 (accessed Sep 12, 2022)

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STOPP/START criteria for potentially inappropriate prescribing in older people: version 3

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STOPP/START criteria for potentially inappropriate prescribing in older people: version 3

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