Subtopic Deep Dive
Potentially Inappropriate Prescribing Elderly
Research Guide
What is Potentially Inappropriate Prescribing Elderly?
Potentially Inappropriate Prescribing (PIP) in the elderly refers to the use of medications with high risk of adverse effects due to age-related physiological changes, comorbidities, or drug interactions, identified using explicit criteria like Beers, STOPP/START.
PIP affects a substantial proportion of older adults, leading to hospitalizations and increased healthcare costs. Tools such as STOPP/START version 2 (O’Mahony et al., 2014, 2310 citations) and version 3 (O’Mahony et al., 2023, 604 citations) screen for PIP alongside under-prescribing. Over 300 studies validate these criteria across Europe and beyond (Fialová, 2005, 703 citations).
Why It Matters
PIP contributes to 6.5% of hospital admissions due to adverse drug reactions (Pirmohamed et al., 2004, 3166 citations), with polypharmacy exacerbating risks (Scott et al., 2015, 1421 citations). Interventions using STOPP/START reduce inappropriate polypharmacy and potential prescribing omissions (Patterson et al., 2014, 761 citations). Clinical decision support systems integrated with these criteria improve prescribing safety in computerized order entry (Kuperman et al., 2006, 765 citations), informing deprescribing guidelines and reducing healthcare burdens worldwide.
Key Research Challenges
Heterogeneity in PIP Criteria
Differences between Beers and STOPP/START criteria lead to varying PIP detection rates. Gallagher and O’Mahony (2008, 687 citations) showed STOPP identifies more hospitalization-related PIMs than Beers. Harmonizing criteria remains unresolved.
Rising Polypharmacy Trends
Polypharmacy and drug-drug interactions increased from 1995–2010, complicating PIP assessment. Guthrie et al. (2015, 787 citations) analyzed population databases revealing this tide. Interventions show limited clinical impact (Patterson et al., 2014, 761 citations).
Implementation in Real-World Practice
Translating screening tools into routine care faces barriers like alert fatigue in CDS systems. Kuperman et al. (2006, 765 citations) reviewed CPOE limitations. European variations in PIM use highlight regulatory and socioeconomic gaps (Fialová, 2005, 703 citations).
Essential Papers
Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients
Munir Pirmohamed, Sally James, Shaun Meakin et al. · 2004 · BMJ · 3.2K citations
Abstract Objective To ascertain the current burden of adverse drug reactions (ADRs) through a prospective analysis of all admissions to hospital. Design Prospective observational study. Setting Two...
What is polypharmacy? A systematic review of definitions
Nashwa Masnoon, Sepehr Shakib, Lisa Kalisch Ellett et al. · 2017 · BMC Geriatrics · 3.0K citations
STOPP/START criteria for potentially inappropriate prescribing in older people: version 2
Denis O’Mahony, David O’Sullivan, Stephen Byrne et al. · 2014 · Age and Ageing · 2.3K citations
Abstract Purpose: screening tool of older people's prescriptions (STOPP) and screening tool to alert to right treatment (START) criteria were first published in 2008. Due to an expanding therapeuti...
Reducing Inappropriate Polypharmacy
Ian Scott, Sarah N. Hilmer, Emily Reeve et al. · 2015 · JAMA Internal Medicine · 1.4K citations
Inappropriate polypharmacy, especially in older people, imposes a substantial burden of adverse drug events, ill health, disability, hospitalization, and even death. The single most important predi...
The rising tide of polypharmacy and drug-drug interactions: population database analysis 1995–2010
Bruce Guthrie, Boikanyo Makubate, Virginia Hernandez Santiago et al. · 2015 · BMC Medicine · 787 citations
Drug regimens are increasingly complex and potentially harmful, and people with polypharmacy need regular review and prescribing optimisation. Research is needed to better understand the impact of ...
Medication-related Clinical Decision Support in Computerized Provider Order Entry Systems: A Review
Gilad J. Kuperman, Andrew J. Bobb, Thomas H. Payne et al. · 2006 · Journal of the American Medical Informatics Association · 765 citations
While medications can improve patients' health, the process of prescribing them is complex and error prone, and medication errors cause many preventable injuries. Computer provider order entry (CPO...
Interventions to improve the appropriate use of polypharmacy for older people
Susan Patterson, Cathal Cadogan, Ngaire Kerse et al. · 2014 · Cochrane Database of Systematic Reviews · 761 citations
It is unclear whether interventions to improve appropriate polypharmacy, such as reviews of patients' prescriptions, resulted in clinically significant improvement; however, they may be slightly be...
Reading Guide
Foundational Papers
Start with Pirmohamed et al. (2004, 3166 citations) for ADR hospitalization burden, then O’Mahony et al. (2014, 2310 citations) for STOPP/START v2 criteria establishing explicit screening standards, followed by Fialová (2005, 703 citations) for European PIM prevalence baselines.
Recent Advances
Study O’Mahony et al. (2023, 604 citations) for STOPP/START v3 updates incorporating new evidence; Scott et al. (2015, 1421 citations) on reducing inappropriate polypharmacy; Masnoon et al. (2017, 3035 citations) clarifying polypharmacy definitions.
Core Methods
Core methods include explicit criteria (STOPP/START, Beers), prospective observational studies for ADR causality (Pirmohamed 2004), population database analyses for trends (Guthrie 2015), and CDS in CPOE (Kuperman 2006).
How PapersFlow Helps You Research Potentially Inappropriate Prescribing Elderly
Discover & Search
PapersFlow's Research Agent uses searchPapers and citationGraph on 'STOPP/START criteria' to map 2310+ citations from O’Mahony et al. (2014), revealing evolution to version 3 (2023). exaSearch uncovers polypharmacy definitions (Masnoon et al., 2017, 3035 citations); findSimilarPapers extends to regional PIP studies like Fialová (2005).
Analyze & Verify
Analysis Agent applies readPaperContent to extract STOPP/START v2 criteria from O’Mahony et al. (2014), then verifyResponse with CoVe checks ADR causality against Pirmohamed et al. (2004). runPythonAnalysis computes polypharmacy prevalence meta-analysis from extracted data using pandas; GRADE grading assesses intervention evidence quality from Patterson et al. (2014).
Synthesize & Write
Synthesis Agent detects gaps in CDS implementation post-Kuperman et al. (2006) and flags contradictions between STOPP/Beers via Gallagher (2008). Writing Agent uses latexEditText for criteria tables, latexSyncCitations for 10+ papers, latexCompile for guidelines, and exportMermaid for polypharmacy intervention flowcharts.
Use Cases
"Meta-analyze polypharmacy prevalence in elderly PIP studies from 2004-2023"
Research Agent → searchPapers('polypharmacy elderly PIP') → Analysis Agent → runPythonAnalysis(pandas meta-analysis on citation counts, prevalences from Masnoon 2017, Guthrie 2015) → CSV export of pooled ORs and forest plot.
"Draft STOPP/START v3 deprescribing guideline with citations"
Synthesis Agent → gap detection (O’Mahony 2023 vs v2) → Writing Agent → latexEditText(structure guideline) → latexSyncCitations(10 papers) → latexCompile(PDF) → researcher gets camera-ready LaTeX guideline.
"Find code for STOPP/START PIM screening validator"
Research Agent → paperExtractUrls(O’Mahony 2014) → Code Discovery → paperFindGithubRepo → githubRepoInspect → researcher gets validated Python screener scripts with usage examples.
Automated Workflows
Deep Research workflow conducts systematic review of 50+ PIP papers: searchPapers → citationGraph(STOPP lineage) → GRADE all interventions → structured report on efficacy. DeepScan applies 7-step analysis to polypharmacy datasets from Guthrie (2015), with CoVe checkpoints verifying ADR attributions. Theorizer generates deprescribing hypotheses from STOPP v3 updates and Scott (2015) interventions.
Frequently Asked Questions
What defines Potentially Inappropriate Prescribing in the elderly?
PIP is defined by explicit criteria like STOPP/START identifying drugs with high adverse event risk in older adults due to pharmacokinetics, interactions, or comorbidities (O’Mahony et al., 2014).
What are key methods for detecting PIP?
STOPP (Screening Tool of Older Persons' Prescriptions) and START criteria screen for inappropriate and omitted prescriptions; version 2 (O’Mahony et al., 2014) updates 2008 originals, outperforming Beers (Gallagher and O’Mahony, 2008).
What are the most cited papers on PIP in elderly?
Top papers include Pirmohamed et al. (2004, 3166 citations) on ADRs causing admissions, O’Mahony et al. (2014, 2310 citations) on STOPP/START v2, and Masnoon et al. (2017, 3035 citations) defining polypharmacy.
What open problems exist in PIP research?
Challenges include inconsistent criteria application, limited intervention impacts (Patterson et al., 2014), rising polypharmacy (Guthrie et al., 2015), and CDS integration barriers (Kuperman et al., 2006).
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