Evidence-Based Guidelines

AGS Beers Criteria®

The updated American Geriatrics Society (AGS) AGS Beers Criteria® were published in 2015. Like the 2012 AGS Beers Criteria®, they include lists of potentially inappropriate medications to be avoided in older adults. New to the criteria are lists of select drugs that should be avoided or have their dose adjusted based on the individual’s kidney function and select drug–drug interactions documented to be associated with harms in older adults. The specific aim was to have a 13-member interdisciplinary panel of experts in geriatric care and pharmacotherapy update the 2012 AGS Beers Criteria® using a modified Delphi method to systematically review and grade the evidence and reach a consensus on each existing and new criterion. The process followed an evidence-based approach using Institute of Medicine standards. The 2015 AGS Beers Criteria® are applicable to all older adults with the exclusion of those in palliative and hospice care.

StoppStart™ Criteria

STOPP & START are new, validated, reliable systems based criteria for potentially inappropriate prescribing. Version 2 of StoppStart™ Criteria was published in 2014 following a Delphi panel assessment by 19 experts in Geriatric Medicine and Pharmacology from 13 European countries.

The 2008 StoppStart™ Criteria were reviewed to add new evidence-based criteria and remove any obsolete criteria. The expert panel agreed a final list of 114 criteria after two Delphi validation rounds, i.e. 80 STOPP criteria and 34 START criteria. This represents an overall 31% increase in StoppStart™ Criteria compared with Version 1. Several new STOPP categories were created in Version 2 – antiplatelet/anticoagulant drugs, drugs affecting, or affected by, renal function and drugs that increase anticholinergic burden; new START categories include urogenital system drugs, analgesics and vaccines

A recent review in PubMed showed 114 articles on StoppStart™ version criteria including 5 systematic reviews, 9 reviews, 71 original research studies using StoppStart™ and 29 commentary articles from 31 countries in Europe, North America, Asia, Australia, South America, Middle East.

EUGMS

The EUGMS originally established a policy group, whose goal is to create a European network of clinicians and researchers devoted to improving the use of drugs in older people.

Secondary goals are the following ones:

• To promote the inclusion of older people in clinical trials;
• To promote appropriate drug prescription in older people, with a particular interest on further development and implementation of the STOPP and START criteria;
• To develop pharmacogenetic research in older patients.

NICE

The recently published NICE guidance on Medicines Optimization recommends using a screening tool – for example the STOPP/START tool in older people – to identify potential medicines-related patient safety incidents for those on multiple medicines or with long term conditions.

US Quality Measures

PIMs now form an integral part of policy and practice in the Centers for Medicare and Medicaid Services (CMS) regulations and are used in Medicare Part D.

They are also used as a quality measure in the National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS). Several stakeholders, including CMS, NCQA, and the Pharmacy Quality Alliance (PQA) have identified theAGS Beers Criteria® as an important quality measure.