Evaluation the Appropriateness of Geriatrics' Medications by Using STOPP/START and Beer's Criteria in Tertiary Care Center in Saudi Arabia

Background: Inappropriate prescribing of medications in the geriatric population causes serious consequences. It increases mortality, mortality, and cost. In addition, it results in polypharmacy, severe adverse drug reactions, drug-drug interactions, and poor adherence. Our study outcome is to identify and assess the prevalence of potentially inappropriate medications (PIMs), potentially omitted medications (POMs) and polypharmacy during hospital admission using the screening tools of older people’s prescriptions (STOPP) / screening tool to alert to right treatment (START) and The American Geriatrics Society (AGS) Beers Criteria (AGS Beers Criteria). 

Methods: We conducted a prospective cohort study in patients aged ≥65 years who were admitted under internal medicine services from April until October 2021. The STOPP/START and AGS Beer's criteria were applied to the patient's clinical profile and concurrent medications list, and PIMs and POMs were recorded. Data were analyzed using SPSS 26.0 version statistical software. Descriptive statistics described the quantitative and categorical variables. Pearson's Chi-square test observed the association between categorical study variables and outcome variables. 

Results: A total of 339 patients were evaluated, 60.9% were females, and 60% were > 75 years of age. The main reasons for the hospitalization were urinary tract infection 26%, acute kidney injury 20.8%, pneumonia 15%, and stroke 12.5%. We recorded 291 PIMs by STOPP, 168 PIMs by AGS Beer's, and 406 POMs by START criteria. The bivariate analysis shows no statistically significant association between age groups, gender, number of reasons for admission, and PIMs. Out of the 3 study variables, only gender was statistically significantly associated with categories of POM, in which a higher proportion (14.8%) female subjects required >4 POM when compared with 5.1% male subjects, whereas 53.2% male subjects required 3 to 4 POM when compared with 46.1% of female subjects (p=0.010). The prevalence of polypharmacy was 82.2%. Among all recorded PIMs, proton pump inhibitors were the most common drug and were used in 26.8% of patients, followed by anti-platelets 4.5%, antipsychotics 4%. While the most common POMs were recorded with vitamin-D and calcium supplements (25.6%) in bed-bound and osteoporotic patients, followed by angiotensin-converting enzyme inhibitors in heart failure and coronary arteries diseases (21%); and Acetylcholinesterase inhibitor in dementia (13.8%).  

Conclusion: PIMs, POMs, and polypharmacy were prevalent among our geriatric population. It requires further assessment to see the impact of our health care outcomes. Standard criteria like STOPP/START or AGS Beer's should be implemented before prescribing medications in geriatrics to improve prescribing practice in these settings.