An elderly patient should be on some drugs but not on others. Barry et al developed the START tool to screen an elderly patient for drugs that should be given. The authors are from Cork University Hospital and University College Cork in Ireland.
Number of screening questions: 22
|
Drug |
Condition |
Exception |
|
warfarin |
chronic atrial fibrillation |
contraindication to warfarin |
|
aspirin |
chronic atrial fibrillation |
contraindication to aspirin |
|
antiplatelet drug (aspirin or clopidigrel) |
coronary, cerebral or peripheral vascular disease in sinus rhythm |
contraindication to antiplatelet drug |
|
antihypertensive medication(s) |
hypertension |
contraindicated |
|
statin |
coronary, cerebral or peripheral vascular disease and life expectancy more than 5 years |
contraindication to statin |
|
ACE inhibitor |
chronic heart failure |
contraindication |
|
ACE inhibitor |
acute myocardial infarction |
contraindication |
|
beta blocker |
chronic, stable angina |
contraindication to beta blocker |
|
inhaled beta-2 agonist or anticholinergic agent |
mild to moderate asthma or COPD |
contraindication |
|
inhaled corticosteroid |
moderate to severe asthma or COPD with reversible airflow obstruction |
contraindication |
|
home continuous oxygen therapy |
chronic type 1 or 2 respiratory failure |
contraindication |
|
L-dopa |
Parkinson's disease with functional impairment |
contraindication |
|
antidepressant therapy (at least 3 months) |
clear-cut depressive symptoms |
contraindications |
|
proton pump inhibitor |
chronic GERD or peptic stricture requiring dilatation |
contraindicated |
|
fiber supplement |
chronic symptomatic diverticular disease with constipation |
|
|
disease modifying anti-rheumatic drug (DMARD) |
moderate to severe rheumatoid arthritis |
contraindication |
|
bisphosphonate |
chronic corticosteroid therapy (> 1 month) |
contraindication |
|
calcium and vitamin D supplement |
known osteoporosis |
|
|
metform |
type 2 diabetes |
contraindication to metformin (renal impairment) |
|
ACE inhibitor or antiogensin receptor blocker (ARB) |
diabetes with nephropathy |
contraindication |
|
aspirin |
diabetes with well-controlled blood pressure |
contraindication to aspirin |
|
statin therapy |
diabetes, elevated cholesterol and cardiovascular risk factors |
contraindication to statin |
Specialty: Pharmacology, clinical
ICD-10: ,
