​Failing to prescribe medications as indicated by the START (Screening Tool to Alert doctors to Right Treatment) list has strong associations with mortality and hospitalization in community-dwelling adults, but "surprisingly," prescribing medications on the STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions) list does not, according to a study published on July 18, 2016 in the British Journal of Clinical Pharmacology. The authors studied 503 Belgian community-dwelling adults age 80 and older for 18 months and found that few patients were prescribed medications appropriately. General practitioners were responsible for collecting the baseline and follow-up data. The researchers defined prescribing "underuse" as failing to prescribe medications as indicated by the START list, and they defined prescribing "misuse" as prescribing medications on the STOPP list. Patients with known dementia and those in palliative care were excluded from the study. Underuse of medication occurred in 67% of patients, while misuse occurred in 56%. There was overlap between patients in whom medications were underused and misused, as just 9% of the population studied experienced neither misuse nor underuse. Underuse of medicine was associated with a 39% increased risk of death and a 26% increased risk of hospitalization, the authors said. These numbers were independent from the number of medications taken and the number of medications misused. Associations with misuse were unclear. The data also suggested a positive correlation between the number of misused medications and the number of underused medications, the authors said. The results should be interpreted "with caution," the authors advised, especially because the results do not allow an inference of causal relations.

HRC Recommends: Older adults are at higher risk for polypharmacy and adverse effects of medications. Tools such as the STOPP, START, and Beers criteria can help prescribers prescribe appropriately and help pharmacists and other healthcare providers check patients' medication regimens for appropriateness. Risk managers should investigate which tools their organization uses to facilitate appropriate prescribing in older adults.