The STOPP/START Criteria: Safeguarding Older Patients Through Medication Review

What STOPP/START Criteria Are

STOPP (Screening Tool of Older Persons’ Potentially Inappropriate Medication) and START (Screening Tool to Alert doctors to Right Treatment) are evidence-based tools designed to identify potentially inappropriate medications in older adults. These criteria focus on common health issues among the elderly, such as polypharmacy, cognitive impairment, and renal insufficiency.

Healthcare providers use STOPP/START to assess whether a medication is appropriate for an individual's condition, age-related factors, and comorbidities, thereby reducing the risk of adverse drug events and optimizing treatment outcomes.

How STOPP/START Criteria Work

The criteria are structured into a series of rules that healthcare providers follow to evaluate medications. Each rule is based on clinical evidence and expert consensus, focusing on specific conditions or medication classes that pose risks for older adults.

For example, STOPP includes rules like 'Antipsychotics in the absence of psychosis' or 'Inappropriate use of sedative hypnotics,' while START provides guidance such as 'Use of a single antihypertensive agent when tolerated and effective.'

Why It Matters

The STOPP/START criteria are crucial in geriatric care because older adults often take multiple medications, increasing the risk of adverse drug interactions and side effects. By systematically reviewing medication regimens using these tools, healthcare providers can identify and address inappropriate prescriptions, leading to safer and more effective treatment.

Implementing STOPP/START also supports evidence-based decision-making, aligns with best practices in geriatric pharmacotherapy, and helps reduce healthcare costs by minimizing unnecessary medications.

Real-World Applications

In practice, the STOPP/START criteria are used during medication reviews for older adults. Healthcare providers document their findings using these tools to justify de-prescribing or adjusting medication regimens based on clinical evidence and patient needs.

For instance, a provider might use STOPP to identify an inappropriate antipsychotic prescription in an elderly patient with cognitive impairment and then work with the patient's family and other healthcare professionals to find safer alternatives.

Frequently asked questions

Try it live

Everything above runs in your browser — open STOPP/START Criteria Medication Review Simulator and change the parameters while it is running. Nothing is installed, nothing is uploaded, the whole model lives in one tab.