Description

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

 


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