Appropriate prescribing in the elderly: Current perspectives

Table 9 Explicit criteria for potentially inappropriate prescribing in older patients

Explicit criteria	Advantages	Disadvantages
Beers criteria[70]	Assesses prescribing quality Useful for education	Several drugs unavailable outside United States Does not include underuse of drugs, drug-drug interactions or duplicate drugs No under-prescribing indicators
Beers criteria[71]	Concise explanation of inappropriateness Severity ratings of adverse outcomes Assesses prescribing quality Useful for education	Several drugs unavailable outside United States Does not include underuse of drugs, drug-drug interactions or duplicate drugs No under-prescribing indicators
Beers criteria[72]	Concise explanation of inappropriateness Severity ratings of adverse outcomes Can be used by computerized clinical information systems	Several drugs unavailable outside the United States Controversy over some drugs labeled as inappropriate No drug to drug interaction No drug disease interactions No under prescribing
Beers criteria[73]	Concise explanation of inappropriateness Structured according to therapeutic classes and organ systems Drug disease interactions	Several drugs unavailable outside United States No drug-drug interaction No under prescribing
STOPP/START[74]	Organised by physiological system Concise list on inappropriate medications Includes drug and disease interactions, therapeutic duplications and prescribing omissions	Does not suggest safer alternatives Does not address certain domains of prescribing, e.g., indication
McLeod criteria[113]	Concise list of inappropriate medications with safer alternatives suggested Useful for education	Obsolete indicators, e.g., beta blockers in heart failure No under-prescribing indicators Several drugs unavailable outside United States
IPET 2000 (Improved prescribing in the elderly tool)[114]	Concise Useful for education	Not comprehensive Predominantly cardiovascular and psychotropic drugs No under-prescribing indicators
Zhans criteria[115]	Less restrictive than previous criteria	Several drugs unavailable outside United States No drug to drug interaction No drug disease interactions No under-prescribing indicators
French Consensus Panel List[116]	Concise explanation of inappropriateness Includes drug duplications Safer alternatives suggested	No clinical studies to date No under prescribing
Rancourt[117]	26 Drug drug interactions 10 drug duplications	Large number of criteria to get through in clinical practice Data only on long term care setting
Australian Prescribing Indicators Tool[118]	Includes drug duplication Includes under-prescribing	Not validated and time consuming Derived from Australian data sources limiting international applicability
Norwegian General Practice (NORGEP) Criteria[119]	Can be applied to medication list with no clinical information	No drug prescribing No drug-disease interactions No studies to date outside Norway
Priscus List[120]	Provides therapeutic alternatives Recommendations on dose adjusting and monitoring	No studies to date published outside Germany
Thailand Criteria[121]	Drug interactions Drug disease interactions	No studies to date outside country of origin