Volume : 13, Issue : 07, July – 2026
Title:
OPTIMIZING PRESCRIBING PRACTICES IN GERIATRIC CARE: A COMPREHENSIVE REVIEW OF THE BEERS AND STOPP/START CRITERIA IN POLYPHARMACY MANAGEMENT
Authors :
Betty George*, Asika Dileep, Jismi Jackson, Honey Mariya Babu, Dr. Aswathy K.A., Dr. Tamil Selvan
Abstract :
Background: Polypharmacy and the subsequent prescription of potentially inappropriate medications (PIMs) represent severe, systemic issues within global geriatric healthcare. As the geriatric population grows exponentially, metabolic shifts and multi-morbidity drastically escalate the risk of adverse drug events (ADEs), treatment non-adherence, and preventable hospital admissions. To combat these outcomes, explicit screening frameworks—most notably the American Geriatrics Society (AGS) Beers Criteria and the Screening Tool of Older Persons’ Prescriptions / Screening Tool to Alert to Right Treatment (STOPP/START) criteria—have been continuously adapted. Objective: This review synthesizes historical contexts, structural milestones, and clinical outcomes associated with the implementation of these criteria across international healthcare environments. Methodology: A structured systematic review of foundational and contemporary literature from 1991 through 2026 was conducted. Evaluated datasets included randomized controlled trials, cross-sectional observational studies, and recent clinical audits evaluating the 2023 versions of both the AGS Beers and STOPP/START guidelines. Results: The evidence demonstrates that polypharmacy remains highly prevalent, ranging from 70% to 89% in specialized cohorts, and is directly linked to elevated PIM usage. Recent 2025 and 2026 data highlight that commonly overprescribed PIM classes include proton pump inhibitors (PPIs), central nervous system (CNS) agents, and inappropriate cardiovascular therapies. Pharmacist-led interventions, software-supported decision systems, and direct patient education consistently show significant reductions in PIM frequency. Conclusion: Routine integration of the 2023 updated Beers and STOPP/START criteria within community pharmacies, tertiary care settings, and long-term care facilities is highly effective for reducing PIMs. Future clinical models must combine automated clinical decision support software with collaborative, interprofessional care teams to optimize safety and mitigate prescribing cascades in the elderly.
Keywords: Beers Criteria, STOPP/START, Polypharmacy, Geriatrics, Potentially Inappropriate Medications.
Cite This Article:
Please cite this article in press Betty George et al., Optimizing Prescribing Practices In Geriatric Care: A Comprehensive Review Of The Beers And Stopp/Start Criteria In Polypharmacy Management, Indo Am. J. P. Sci, 2026; 13(07).
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29. Tommelein, E., Mehuys, E., Petrovic, M., Somers, A., Colin, P., & Boussery, K. (2015). Potentially inappropriate prescribing in community-dwelling older people across Europe: A systematic review. European Journal of Clinical Pharmacology, 71(12), 1415–1427. https://doi.org/10.1007/s00228-015-1954-4
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33. Al-Azayzaih, A., Al-Azzam, S., Alzoubi, K. H., Al-Hajji, M., & Karasneh, R. (2021). Evaluation of potentially inappropriate medications prescribed for elderly patients using the 2019 Beers Criteria. Journal of Evaluation in Clinical Practice, 27(5), 1145–1151. https://doi.org/10.1111/jep.13511
34. Alhmoud, E., Khalifa, S., & Bahi, A. (2023). Adherence to prescribing guidelines for older adults in emerging health systems: A systematic evaluation of Beers and STOPP criteria usage. Frontiers in Pharmacology, 14, 110–123. https://doi.org/10.3389/fphar.2023.1110293
35. Bakale, S. (2025). Prospective observation study to assess prescription appropriateness in elderly patients by using Beers Criteria. Zhuzao/Foundry, 74(5), 594–602.
36. Beers, M. H., Ouslander, J. G., Rollingher, I., Reuben, D. B., Brooks, J., & Beck, J. C. (1991). Explicit criteria for determining inappropriate medication use in nursing home residents. Archives of Internal Medicine, 151(9), 1825–1832. https://doi.org/10.1001/archinte.1991.00400090107019
37. Cojuc-Konigsberg, G. (2024). Inappropriate medication in the geriatric population. StatPearls [Internet]. StatPearls Publishing.
38. Croke, L. (2020). Beers Criteria for inappropriate medication use in older patients: An update from the AGS. American Family Physician, 101(1), 56–57.
39. Dalton, K., Byrne, S., Cullinan, S., & O’Mahony, D. (2021). Application of software-supported STOPP/START criteria in a hospital setting: Impact on drug-related problems. International Journal of Clinical Pharmacy, 43(2), 311–320. https://doi.org/10.1007/s11096-020-01141-w
40. Frankenthal, D., Lerman, Y., Kalendaryov, E., & Saban, M. (2014). Intervention with the Beers Criteria for elderly patients in a nursing home: A randomized controlled trial. Israel Journal of Health Policy Research, 3(1), 9–17. https://doi.org/10.1186/2045-4015-3-9
41. Gnjidic, D., Hilmer, S. N., Blyth, F. M., Naganathan, V., Waite, L., Seibel, M. J., … & Le Couteur, D. G. (2012). Polypharmacy cutoff and outcomes: Older people take five or more drugs have significant drug-related problems. Age and Ageing, 41(1), 101–109. https://doi.org/10.1093/ageing/afr124
42. Hamilton, H., Gallagher, P., Ryan, C., Byrne, S., & O’Mahony, D. (2011). Potentially inappropriate medications defined by STOPP criteria and the risk of adverse drug events in older hospitalized patients. Archives of Internal Medicine, 171(11), 1013–1019. https://doi.org/10.1001/archinternmed.2011.215
43. Hinton, E. D. (2024). Staff education module on Beers Criteria for geriatric patients [Doctoral dissertation, Walden University]. ScholarWorks.
44. Karimi, R. (2026). Evaluation of Beers Criteria implementation in the community pharmacy setting to optimize medication management for older adults—A pilot study. Pharmacy, 14(1), 11–22.
45. Kaufmann, C. P., Tremp, R., Hersberger, K. E., & Lampert, M. L. (2020). Inappropriate prescribing: A systematic overview of published assessment instruments for mature adults. European Journal of Clinical Pharmacology, 76(12), 1611–1626. https://doi.org/10.1007/s00228-020-02958-8
46. Liew, N. Y., Devados, J., Toot, J. W., & Khan, T. M. (2019). Assessment of drug-related problems and evaluation of pharmacist interventions in a geriatric oncology clinic. Journal of Oncology Pharmacy Practice, 25(4), 855–863. https://doi.org/10.1177/1078155218764421
47. Mahavadia, M. (2025). Prescription analysis of post-stroke patients attending geriatric clinic on the basis of Beers Criteria 2023. International Journal of Medical and Pharmaceutical Research, 6(2), 2042–2049.
48. Maher, R. L., Hanlon, J., & Hajjar, E. R. (2014). Clinical consequences of polypharmacy in elderly patients. Expert Opinion on Drug Safety, 13(1), 57–65. https://doi.org/10.1517/14740338.2013.827660
49. Martin, P., Tamblyn, R., Ahmed, S., & Tannenbaum, C. (2018). An educational intervention to reduce the use of potentially inappropriate medications among older adults (EMPOWER): A cluster randomized trial. JAMA Internal Medicine, 178(11), 1563–1571. https://doi.org/10.1001/jamainternmed.2018.4150
50. Milos, V., Recordat, A., Casa-Valenti, P., & Santos-Ruiz, M. (2022). Comparative accuracy of Beers Criteria vs. STOPP/START criteria in detecting drug-related admissions: A systematic review. Drugs & Aging, 39(6), 421–433. https://doi.org/10.1007/s40266-022-00945-8
51. Morin, L., Laroche, M. L., Texier, G., & Johnell, K. (2016). Prevalence of potentially inappropriate medication use in older adults with multi-morbidity: A systemic review. Journal of the American Medical Directors Association, 17(9), 862–871. https://doi.org/10.1016/j.jamda.2016.06.012
52. Nothelle, S. K., Sharma, R., Ommaya, A., & Segal, J. (2019). Explicit criteria to identify potentially inappropriate prescribing in older adults: A systematic review of global tools. Journal of the American Geriatrics Society, 67(11), 2410–2419. https://doi.org/10.1111/jgs.16113
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54. O’Mahony, D., Cherubini, A., Guiteras, A. R., Denkinger, M., Beuscart, J. B., Jennings, E., … & Gallagher, P. (2023). STOPP/START criteria for potentially inappropriate prescribing in older people: version 3. European Geriatric Medicine, 14(4), 625–632. https://doi.org/10.1007/s41999-023-00777-y
55. Pazan, F., & Wehling, M. (2021). Polypharmacy in older adults: A narrative review of definitions, epidemiology and prognosis. European Geriatric Medicine, 12(3), 443–452. https://doi.org/10.1007/s41999-021-00479-3
56. Saka, S. A., Nlooto, M., & Oosthuizen, F. (2018). American Geriatrics Society-Beers Criteria and adverse drug reactions: A comparative cross-sectional study of Nigerian and South African older inpatients. Clinical Interventions in Aging, 13, 2375–2387. https://doi.org/10.2147/cia.s176899
57. Staff, A. U. A. (2015). The Beers Criteria for potentially inappropriate medication use in older adults. American Urological Association Education and Research, 4(2), 1–12.
58. Thomas, R., & Huntley, A. L. (2020). The effectiveness of interventions to optimize prescribing for older adults in primary care: A systematic overview. British Journal of General Practice, 70(695), 412–421. https://doi.org/10.3399/bjgp20X709505
59. Tommelein, E., Mehuys, E., Petrovic, M., Somers, A., Colin, P., & Boussery, K. (2015). Potentially inappropriate prescribing in community-dwelling older people across Europe: A systematic review. European Journal of Clinical Pharmacology, 71(12), 1415–1427. https://doi.org/10.1007/s00228-015-1954-4
60. Vittalrao, A. M., Reddy, N., Hegde, S., Sujaini, S., & Kumari Kamalkishore, M. (2025). Potentially inappropriate medications in geriatric patients attending a tertiary care hospital in South India: An observational cross-sectional study. Gulhane Medical Journal, 67(1), 12–19. https://doi.org/10.4274/gulhane.galenos.2024.70370.