An evaluation of the appropriateness of prescribing and frailty in elderly patients using STOPP criteria and Frailty Index in tertiary care teaching hospital


Submitted: 7 May 2021
Accepted: 27 September 2021
Published: 25 November 2021
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People above 65 years of age would amount to 10.7% of total population of India by 2021. India has acquired the label of ‘an ageing nation’ with 7.7% of its population being more than 60 years old. Geriatric patients are exposed to potentially inappropriate medications (PIMs) thus strategies to improve quality of life and safety of prescribing is needed. One such explicit criteria tool is ‘Screening Tool of Older person’s Potentially inappropriate Prescriptions’ (STOPP) criteria. For older individuals, frailty plays a decisive role. Frailty assessment is useful for identification of risk stratifications to assist in clinical decision makings. Hence, this study is aimed to assess the percentage of PIM using STOPP criteria and correlation between PIMS and Frailty Index (FI) in elderly patients in our setting. An observational study was done in 60 patients in department of medicine at tertiary care teaching hospital. Demographic details, diagnosis and current medications were recorded in Microsoft excel 2016. PIMs based on STOPP criteria version 2 and FI suggested by Searle et al. was calculated and analyzed. Spearman rank correlation test was used to check the correlation between FI and PIM. Out of 60 prescriptions, 21 prescriptions with PIM were found. Most common drugs prescribed as PIM were Aspirin, calcium, ceftriaxone, multivitamin B complex and furosemide. FI was analyzed by using 34 variables. Value of FI was between 0.03 to 0.17. Spearman Rank correlation test showed direct low degree of significant correlation between FI and PIM with correlation (r) value of 0.1602 (P value=0.02). 35% of prescriptions were having at least one PIM in our study and we found that there was direct association between FI and PIM which will help us to reduce potential medication errors, drug interactions and adverse reactions.


Dey S, Nambiar D, Lakshmi JK, Sheikh K, Reddy KS. Health of the elderly in India: challenges of access and affordability. National Academies Press (US); 2012.

Ingle GK, Nath A.Geriatric Health in India: concerns and solutions. Indian J Community Med 2008;33:214-8. DOI: https://doi.org/10.4103/0970-0218.43225

Lavan AH, Grady J, Gallagher PF. Appropriate prescribing in the elderly: current perspectives. World J Pharmacol 2015;4:193-209. DOI: https://doi.org/10.5497/wjp.v4.i2.193

Moisan J, Baillargeon L, Verreault R, et al. Potentially inappropriate prescriptions for older patients in long-term care. BMC Geriatrics 2004;4:9. DOI: https://doi.org/10.1186/1471-2318-4-9

Jang I. Frailty and comprehensive geriatric assessment. J Korean Med Sci 2020;35:e16. DOI: https://doi.org/10.3346/jkms.2020.35.e16

Searle SD, Mitnitski A, Gahbauer EA, et al. A standard procedure for creating a frailty index. BMC Geriatrics 2008;8-24. DOI: https://doi.org/10.1186/1471-2318-8-24

Vishwas HN, Anand Harugeri A, Parthasarathi G, Madhan R. Potentially inappropriate medication use in Indian elderly: comparison of Beers’ criteria and STOPP criteria. Geriatr Gerontol Int 2012;1-9.

Murthy MB, Jagtap K, Burute SR, et al. Geriatric prescription analysis with respect to ‘STOPP’ and ‘START’ criteria: a descriptive study in the Indian scenario. Int J Basic Clin Pharmacol 2017;6:2864-70. DOI: https://doi.org/10.18203/2319-2003.ijbcp20175209

Kanagasanthosh K, Topno I, Aravindkumar B. Prevalence of potentially inappropriate medication use and drug utilization pattern in elderly patients: a prospective study from a tertiary care hospital. Int J Res Med Sci 2015;3:2062-72. DOI: https://doi.org/10.18203/2320-6012.ijrms20150328

Porter B, Arthur A, Savva GM. How do potentially inappropriate medications and polypharmacy affect mortality in frail and non-frail cognitively impaired older adults? A cohort study. BMJ Open 2019;9:e026171. DOI: https://doi.org/10.1136/bmjopen-2018-026171

Dagli RJ, Sharma A. Polypharmacy: a global risk factor for elderly people. J Int Oral Health 2014;6(6).

Herr M, Sirven N, Grondin H, et al. Fraility,polypharmacy and potentially inappropriate medications in old people:findings in a representative sample of the French population. Eur J Clin Pharmacol 2018 [Epub ahead of print]. DOI: https://doi.org/10.1007/s00228-017-2276-5

Alsuwaidan A, Almedlej N, Sawsan A, et al. A comprehensive overview of polypharmacy in elderly patients in Saudi Arabia. Geriatrics (Basel) 2019;4:36. DOI: https://doi.org/10.3390/geriatrics4020036

Gallagher P, O’Mahony D. STOPP: application to acutely ill elderly patients and comparison with Beers’ criteria. Age Ageing 2008;37:673-9. DOI: https://doi.org/10.1093/ageing/afn197

Mathur A, Shah PC. Potentially inappropriate prescribing in elderly: a comparison of Beers and STOPP criteria in tertiary care. Int J Basic Clin Pharmacol 2019;8:95-9. DOI: https://doi.org/10.18203/2319-2003.ijbcp20185164

Nathwani D, Dugid M, Brown N, et al. Antimicrobial stewardship from principles to practice. Chapter no. 167. BSAC 2018;13-37:72-7.

Clegg A, Young J, Iliffe S, et al. Frailty in elderly people. Lancet 2013;381:752-62. DOI: https://doi.org/10.1016/S0140-6736(12)62167-9

Cullinan S, Mahony D, Sullivan D. Use of a frailty index to identify potentially inappropriate prescribing and adverse drug reaction risks in older patients. Age Ageing 2016;45:115-20. DOI: https://doi.org/10.1093/ageing/afv166

Khera S, Abbasi M, Dabravolskaj J, et al. Appropriateness of medications in older adults living with frailty: impact of a pharmacist-led structured medication review process in primary care. J Prim Care Commun Health 2019;10:1-8. DOI: https://doi.org/10.1177/2150132719890227

Nariya, S., Pillai, A., & Agravat, S. (2021). An evaluation of the appropriateness of prescribing and frailty in elderly patients using STOPP criteria and Frailty Index in tertiary care teaching hospital. Geriatric Care, 7(2). https://doi.org/10.4081/gc.2021.9845

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