The AHRQ PSNet Collection comprises an extensive selection of resources relevant to the patient safety community. These resources come in a variety of formats, including literature, research, tools, and Web sites. Resources are identified using the National Library of Medicine’s Medline database, various news and content aggregators, and the expertise of the AHRQ PSNet editorial and technical teams.
O’Mahony D, Cherubini A, Guiteras AR, et al. Eur Geriatr Med. 2023;14:625-632.
STOPP (Screening Tool of Older Persons’ Prescriptions) and START (Screening Tool to Alert to Right Treatment) criteria are used to identify potentially inappropriate prescribing in older adults. This article describes the consensus process to update and validate the third version of the STOPP/START criteria using evidence from a systematic review and input from a panel with expertise in geriatric pharmacology. The consensus process resulted in additional STOPP criteria (133 versus 80 in version 2) and START criteria (57 versus 34 in version 2). The additional criteria in version 3 can help clinicians detect and prevent adverse drug-drug and drug-disease interactions.
Thevelin S, Pétein C, Metry B, et al. BMJ Qual Saf. 2022;31:888-898.
Polypharmacy can place older adults at increased risk of adverse drug events. This mixed-methods study, embedded in the OPERAM trial, identified differences in perceived shared decision-making regarding medication changes between providers and older adult patients. Whereas clinicians reported high levels of shared decision-making, patients reported poor communication and paternalistic decision-making.
Zerah L, Henrard S, Thevelin S, et al. Age Ageing. 2022;51:afab196.
Adverse drug events (ADEs) are an important cause of hospitalizations in older adults. Based on data from the OPERAM trial, this study explored the accuracy of triggers for identifying medication-related hospital admissions in older adults. Triggers were related to diagnoses (e.g., falls, bleeding, thromboembolic events), laboratory values (e.g., hypo- or hyperglycemia) and other factors (e.g., mention of an ADE in the patient record, abrupt medication discontinuation). Among 1,235 included hospitalizations, 58% cases had at least one trigger; medication-related admissions were adjudicated in 72% of these cases.
Blum MR, Sallevelt B, Spinewine A, et al. BMJ. 2021;374:n1585.
Older adults with multimorbidity and polypharmacy are at increased risk of adverse drug events. This cluster randomized controlled trial compared drug-related hospitalization rates of older adults who received a structured deprescribing intervention and those who received usual care. While rates of polypharmacy decreased, there was no effect on drug-related hospitalizations.
O'Mahony D, O'Sullivan D, Byrne S, et al. Age Ageing. 2015;44:213-218.
This consensus guideline describes expanded criteria to identify inappropriate medication prescribing for older patients. This strategy can address high rates of adverse drug events in older populations, especially if integrated into clinical decision support.
Hamilton H, Gallagher P, Ryan C, et al. Arch Intern Med. 2011;171:1013-9.
Many medications, particularly sedatives and other drugs with significant side effects, are considered inappropriate for prescribing in elderly patients. However, the existing Beers criteria for appropriateness lack predictive power for adverse drug events. This prospective cohort study reports on the validation of the STOPP criteria, a novel list of medications considered inappropriate for elderly patients. Patients who received medications considered inappropriate by STOPP had a nearly two-fold increased odds of an adverse drug event during hospitalization, while the Beers criteria failed to predict medication errors. Given the recognized limitations of the Beers criteria, the STOPP criteria likely represent a superior method of identifying dangerous medications in geriatric patients.