A Comparison of the STOPP/START Criteria and the Beers Criteria as Applicable to the U.S. Nursing Home Population

Research Category: Health Sciences
Presenter: Diana Ching
PI: Becky Briesacher

Motivation: In U.S. nursing homes (NH), 40% of residents receive ≥9 different medications, which may be clinically inappropriate. The Screening Tool of Older Person’s Prescriptions (STOPP)/Screening Tool to Alert doctors to Right Treatment (START) criteria, developed in Ireland, detects potentially inappropriate medications (PIMs) and treatment omissions. The Beers criteria identify PIMs in older U.S. patients. Neither criteria was developed for NH residents.

Problem statement: Identify dissimilarities between the 25 STOPP/START criteria and the Beers criteria as applicable to U.S. NH patients.

Approach: Using a modified Delphi process, an online consensus panel of NH experts identified 25 STOPP/START criteria that are most relevant to the U.S. NH population. We compared the 25 STOPP/START criteria to the Beers criteria for agreeable or inconsistent treatment recommendations.

Results: Of the 25 STOPP/START criteria considered, 18 were in agreement with the Beers criteria. Five STOPP criteria were lacking in the Beers criteria and recommend discontinuation of the following medications under certain circumstances: systemic corticosteroids instead of inhaled corticosteroids in COPD, proton pump inhibitors >8 weeks, antimuscarinic drugs in chronic prostatism, metformin in renal dysfunction, and oral elemental iron >200 mg/day. Beers criteria had no comparable recommendations for the 2 START criteria: consideration of annual influenza vaccines and the pneumococcal vaccine at least once if ≥65 years old.

Conclusion: There is substantial overlap between the STOPP/START criteria and Beers criteria in the context of a NH population. Both tools may be useful for providing appropriate care in the U.S. NH environment.