The Use of STOPP/START Criteria for Medication Intervention Among Elderly Population Living in a Geriatric Hospital

Study Overview
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Brief Summary
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The purpose of this study is to determine if the use of STOPP/START criteria (STOPP-screening tool of older persons potentially inappropriate prescriptions START-screening tool to alert doctors to right treatment)for medication intervention in elderly population living in a geriatric hospital will lower the number of falls,hospitalization,will improve functioning, quality of life and reduce financial costs.

Detailed Description
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Inappropriate prescribing is common in older people and is associated with adverse drug effects,hospitalization and falls. In this trial we want to check the efficacy of the screening tools STOPP/START which were developed and validated in order to reduce inappropriate prescribing. STOPP comprises of 65 indicators of drug-drug, drug-disease interactions and therapeutic duplication. START incorporates 22 evidence based indicators of common prescribing omissions. We will conduct a randomized controlled trial to test the hypothesis that screening the medications of older patients living permanently in a geriatric hospital will improve their quality of life. The compliance of the doctor working in the geriatric hospital to the recommendations of the screening tools will also be checked.

Official Title
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The Use of STOPP/START Criteria for Medication Intervention and the Risk of Falls, Hospitalization, Functioning and Quality of Life Among Elderly Population Living in a Geriatric Hospital in Israel and Comparison to Beers

Conditions
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Adverse Drug Effects

Intervention / Treatment
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* Other: STOPP/START screening tools for medication intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: age over 65 live in the geriatric hospital Givaat Hashlosha permanently. Exclusion Criteria: people with a terminal illness that will not live more than a year. people who enter the geriatric hospital for a short while (are not permanent).

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Screening
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Controll<br>The medications in this arm will not be screened. | |
| Active Comparator: Intervention screening medication group<br>STOPP/START screening tools are used for medication intervention | Other: STOPP/START screening tools for medication intervention<br>* In the intervention arm the investigator will use the screening tools STOPP/START to screen the medications.<br>* Other names: medication intervention;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quality of Life- Mental Component Summaty (MCS) | Quality of life will be measured by MOS SF-12 Health Survey questionnare. Results are expressed in terms of two meta scores: The Physical Component Summary(PCS) and the Mental Component Summary (MCS). The PCS and MCS scores have a range of 0 to 100, thus scores greater than 50 represent a better than average health status. | Outcome measures were assessed at the end of the 12 month follow up | 
| SF-12 Health Survey questionnaire-the Physical Component Summary (PCS) | Quality of life was assessed by the SF-12 Health Survey questionnare. Results are expressed in terms of two meta scores:the Physical Component Summary (PCS) AND Mental Component Summary (MCS). The PCS and MCS scores have a range of 0 to 100, thus scores greater than 50 represent a better than average health status. | Outcome measures were assessed at the end of the 12 month follow up | 
| Falls | Average number of falls per year. | At the end of the 12 month follow up | 
| Hospitalizations | The average number of hospitalizations per year. | Outcome measures were assessed at the end of the 12 month follow up | 
| Functional Independence Measure (FIM) | Functioning was assessed by the FIM score. The FIM rates 18 activities of daily living on a 7 point scale ranging from fully dependent (=1) to independent (=7). A maximum score of 126 indicates functional independence and the lowest score of 18 indicates functional dependence. | Outcome measures were assessed at the end of the 12 month follow up | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pharmacoeconomics Analysis-Costs of Medication | The costs on medications in the geriatric hospital before and after intervention e.g. pharmaeconomic analysis of the intervention. Costs of medications were calculated in New Israeli shekels per month and taken from the Ministry of Health's medication price list. | Outcome measures were assessed at the end of the 12 month follow up | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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STOPP screening tool, START screening tool, MIP-medication inappropriate prescription, PIM-Potentially inappropriate medication