Gallagher et al used the STOPP (Screening Tool of Older Person's Prescriptions) to help guide therapy in older adults. Prescription categories include musculoskeletal and pain disorders. The authors are from Cork University in Ireland.
Patient selection: age >= 65 years
|
Musculoskeletal Disorder |
Comorbid |
Other |
Adverse Effect |
|
NSAID |
peptic ulcer disease or GI hemorrhage |
without concurrent histamine H2 receptor antagonist, PPI, or misoprostol |
peptic ulcer relapse |
|
NSAID |
moderate or severe hypertension |
|
worsening of hypertension |
|
NSAID |
heart failure |
|
exacerbation of CHF |
|
NSAID, long term (> 3 months) |
mild osteoarthritis |
|
simple analgesic preferred |
|
NSAID |
|
with warfarin |
GI bleeding |
|
NSAID |
chronic renal failure (CRF) |
|
worsening of renal failure |
|
corticosteroids, long term |
rheumatoid arthritis |
|
side effects corticosteroids |
|
corticosteroids, long term |
osteoarthritis |
|
side effects corticosteroids |
|
NSAID, long term |
gout |
no contraindications to allopurinol |
allopurinol preferred |
|
colchicine |
gout |
no contraindication to allopurinol |
allopurinol preferred |
|
Pain |
Comorbid |
Other |
Adverse Effect |
|
opiates, long-term |
mild to moderate pain |
|
not following WHO analgesic ladder |
|
opiates, regular for > 2 weeks |
chronic constipation |
without laxatives |
severe constipation |
|
opiates, long-term |
dementia |
neither palliative care nor severe chronic pain |
worsening of cognitive impairment |
where:
• NSAID = nonsteroidal anti-inflammatory drug
Specialty: Pharmacology, clinical
