Potentially inappropriate drug use among hospitalised older adults: results from the CRIME study

Background: Beers criteria and screening tool of older person's prescriptions (STOPP) criteria are widely used to assess potentially inappropriate drug use (PIDU). Objective: the aims of the present study are (i) to assess the prevalence of PIDU based on 2012 Beers criteria and STOPP criteria and (ii) to determine the impact of PIDU, as defined by these criteria, on health outcomes among older in-hospital patients. Design: prospective observational study. Setting and subjects: a total of 871 in-hospital patients participating to the CRIteria to Assess Appropriate Medication Use among Elderly Complex Patients project. Methods: outcome measures were (i) adverse drug reactions (ADR); (ii) decline in functional status; (iii) combined outcome (ADR or declined in functional status). Results: the prevalence of PIDU was 58.4% applying Beers criteria, 50.4% applying STOPP criteria and 75.0% combining both sets of criteria. PIDU defined based on STOPP criteria was significantly associated with ADR [odds ratio (OR) 2.36; 95% confidence interval (CI) 1.10-5.06], and decline in physical function (OR: 2.00; 95% CI: 1.10-3.64), while, despite a positive trend, no significant association was observed for Beers criteria or the combination of both criteria. The combined outcome was significantly associated with PIDU defined based on Beers (OR: 1.74; 95% CI: 1.06-2.85), STOPP criteria (OR: 2.14; 95% CI: 1.32-3.47) or both (OR 2.02; 95% CI: 1.06-3.84). Conclusions: PIDU is common in hospitalised older adults and the combination of Beers and STOPP criteria might lead to the identification of a larger number of cases of PIDU than the application of a single set of criteria. STOPP criteria significantly predict all in-hospital outcomes considered, while Beers criteria were significantly associated with the combined outcome only.