Inappropriate Prescribing in the Elderly

Multicenter Observational Study on the Prevalence of Inappropriate Prescribing in Elderly Patients At Admission and Discharge from a Hospital Ward Using the STOPP/START Criteria

Status

Completed

Phases

Unknown

Study type

Observational

Source

ClinicalTrials.gov

Registry ID

NCT06760728

Acronym

STOPP&START

Enrollment

100

Registered

2025-01-07

Start date

2015-07-01

Completion date

2016-08-01

Last updated

2025-01-07

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Elderly (people Aged 65 or More), Hospitalized, Prescriptions, Prevalence

Keywords

polypharmacotherapy, medication review, Drug interactions, elderly patients, deprescribin, STOPP/START criteria, of potentially inappropriate prescriptions (PIPs), potential omitted prescriptions (PPOs), PIPs, POPs, Hospital

Brief summary

The management of pharmacotherapy in elderly patients is an increasingly critical aspect, as polypharmacy, combined with the pharmacokinetic and pharmacodynamic changes typical of aging, makes older adults more sensitive to the development of adverse reactions. This highlights the importance of appropriate use of pharmacotherapy that considers the risks and benefits of individual treatments. The aim of this study is to measure the prevalence of pharmacological appropriateness using the STOPP/START criteria (version 2) at admission and discharge from an acute geriatric ward, thereby evaluating the impact of hospitalization on medication prescribing.

Interventions

None listed

Study design

Observational model

COHORT

Time perspective

PROSPECTIVE

Eligibility

Sex/Gender

ALL

Age

70 Years to No maximum

Healthy volunteers

Inclusion criteria

* Patients aged ≥ 70 years admitted to a geriatric ward * Regardless of ethnicity, gender, or type of illness * Patients transferred from another ward * Patients admitted to another ward for support

Exclusion criteria

• Patients in the terminal phase (\<6 months life expectancy) Criteria for exit from the study (Dropout): * Patients transferred to another hospital ward * Patients who have deceased

Design outcomes

Primary

Measure	Time frame	Description
Prevalence of inappropriate prescribing in elderly patients at admission to an acute care hospital using STOPP/START criteria	Data collected at time Day 0 is analyzed by day 4. Data collected at time Day 1 is analyzed by day 4	The analysis of inappropriate prescriptions at admission Day 0 will be evaluated as a single outcome measure by aggregating data using the STOPP/START criteria. Specific assessments will be reported separately, as they involve different types of information and units of measure: * Prevalence of inappropriate prescriptions: The proportion of patients with prescriptions deviating from STOPP/START criteria (%). * Characteristics of patient history: Data such as active and passive diseases (count), place of origin (categorical variable), reason for admission (categorical variable), and presence of ADL support (binary variable: Yes/No). * Clinical indicators: Charlson Comorbidity Index (numerical score), number of medications (count), presence of geriatric syndromes (binary variable: Yes/No). * Mobility status: Whether the patient is bedridden or ambulatory (categorical variable). * Hospitalization history: Number of admissions in the past year (count).

Secondary

Measure	Time frame	Description
Prevalence of inappropriate prescribing in elderly patients at discharge from an acute care hospital using STOPP/START criteria.	Data collected at time Day 0 is analyzed by day 4. Data collected at time Day 1 is analyzed by day 4	This analysis focuses on the prevalence of inappropriate prescriptions at discharge Day 1, defined according to adherence to or deviation from the recommendations specified in the STOPP/START criteria. -Prevalence of Inappropriate Prescriptions (%): The proportion of patients with prescriptions deviating from the STOPP/START criteria. -Destination After Discharge: Categorical variable (e.g., home alone, home with assistance, nursing home, rehabilitation unit). * Length of Stay (Days) * Presence of Geriatric Syndromes (delirium, cognitive decline, urinary ) during Hospitalization Unit of Measurement: Binary variable (Yes/No). * Barthel Index at Discharge Unit of Measurement: Numerical score (in points). Description: The Barthel Index score at the time of discharge. Information for each outcome measure will be obtained from discharge letters and from the physician who cared for the patient for the majority of the hospitalization.
Percentage of cases in which inappropriate prescribing will be detected at admission and discharge	Data collected at time Day 0 is analyzed by day 4. Data collected at time Day 1 is analyzed by day 4	Percentage of cases in which inappropriate prescriptions are identified at the time of admission Day 0 and discharge Day 1 for each of the individual STOPP/START criteria, i.e., for each of its recommendations.
Association between the prevalence of inappropriate prescriptions and clinical variables, measured using univariate and multivariate regression.	Data collected at time Day 0 is analyzed by day 4. Data collected at time Day 1 is analyzed by day 4	The association between the prevalence of inappropriate prescriptions at the time of admission Day 0 and discharge Day 1 and clinical variables of interest (such as place of origin, level of care, comorbidities, polypharmacy, and multidimensional geriatric assessment) was analyzed using univariate and multivariate regression. The univariate regression explored the association of each variable with the prevalence of inappropriate prescriptions, while the multivariate regression was used to estimate the simultaneous effect of multiple variables, controlling for potential confounding factors.

Countries

Italy

Outcome results