Comparison of Beers Criteria and STOPP/START (Screening Tool of Older Persons’ Prescriptions/Screening Tool to Alert to Right Treatment) Criteria for Assessing Inappropriate Drug Use Among Elderly Patients

Introduction: Prescribing inappropriate drugs is common among older patients due to the presence of multiple comorbidities. Inappropriate drug usage can cause adverse drug reactions, leading to increased risk of hospitalization and mortality. The two most widely used tools among the western population are Beers and STOPP/START (Screening Tool of Older Persons’ Prescriptions/Screening Tool to Alert to Right Treatment) criteria. Comparing these tools among the Indian population will help determine which is more effective in identifying inappropriate drugs and guiding physicians on safer drug usage among elders. Methods: Geriatric patients aged more than 60 years on at least one chronic medication visiting the OPD or admitted to the ward (n=140) were included in the study. The prescriptions were reviewed with both the Beers and the STOPP/START tool to identify inappropriate medication. Agreement analysis between the two criteria was done using kappa statistics. Results: The mean age of study participants was 67.8 ± 6.3 years, with 55.7% male patients. Hypertension with cardiovascular disease (73.6%) and diabetes (50.7%) were the most common diseases. Of the total 523 drugs taken by study participants, 61 (11.6%) and 47 (8.9%) drugs had to be stopped based on STOPP and Beer’s criteria, respectively. Using the START criteria, a total of 34 medications had to be added to the existing medication. There was only slight agreement between the two tools (kappa value: 0.093). Conclusion: The study found a low concordance proportion among the two criteria, suggesting a limited application of these tools among only a specific population of a country in which it was devised. We suggest the need to develop a specific tool to detect inappropriate medication for the Indian population.