Beers criteria
(Explicit tool) | First widely used explicit criteria Contains over 200 criteria (2023 version) including potentially inappropriate medications to be avoided such as drug disease and drug–drug interactions, particularly in older adults.
| International studies have shown predictive validity for adverse drug reactions, falls, cognitive function, hospitalisation and death. Endorsed by the American Geriatric Society and updated approximately every 3–4 years. Easier to automate in drug records as criteria are specific
| No positive clinical outcomes in RCTs to date No prioritisation of medications for review Can be challenging to use as long list of criteria Does not address underprescribing Focus is on individual medications rather than polypharmacy as a whole
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Screening Tool of Older Person’s Prescriptions/ Screening Tool to Alert doctors to Right Treatment—STOPP/START
(Explicit tool, but newer versions also contain implicit measures) | One of the most widely used explicit criteria globally for older adults Contains 133 criteria for potentially inappropriate medications, and 57 potential underprescribing criteria (version 3), organised according to medication and disease groups
| Some positive outcomes shown in several RCTs Also addresses aspects of underprescribing in addition to overprescribing Easier to automate in computerised drug records as most criteria are specific
| Misses out medications out of criteria Can be challenging to use as long list of criteria No prioritisation of medications for review Focus is on individual medications rather than polypharmacy as a whole
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Medication Appropriateness Index—MAI
(Implicit tool) | First widely used implicit criteria Lists 10 criteria that evaluate various aspects of medication appropriateness (eg, indication, effectiveness, dose)
| | Time consuming to execute Requires clinical expertise and can be subjective Difficult to automate No prioritisation of medications for review Focus is seldom on polypharmacy as a whole or underprescribing
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Drug Burden Index—DBI
(Implicit tool, as requires further judgement to evaluate appropriateness after calculating score) | | International studies have shown predictive validity for falls, fractures, general practice visits and admission. Takes into account licenced doses to allow transferability between counties Easier to automate in drug records.
| No positive clinical outcomes in RCTs to date No consideration for appropriateness or specific indication of medicines Only focused on sedatives, and anticholinergics Can be challenging to calculate at point of care unless computerised Does not address polypharmacy as a whole or underprescribing
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