STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation

Int J Clin Pharmacol Ther. 2008 Feb;46(2):72-83. doi: 10.5414/cpp46072.


Objective: Older people experience more concurrent illnesses, are prescribed more medications and suffer more adverse drug events than younger people. Many drugs predispose older people to adverse events such as falls and cognitive impairment, thus increasing morbidity and health resource utilization. At the same time, older people are often denied potentially beneficial, clinically indicated medications without a valid reason. We aimed to validate a new screening tool of older persons' prescriptions incorporating criteria for potentially inappropriate drugs called STOPP (Screening Tool of Older Persons' Prescriptions) and criteria for potentially appropriate, indicated drugs called START (Screening Tool to Alert doctors to Right, i.e. appropriate, indicated Treatment).

Methods: A Delphi consensus technique was used to establish the content validity of STOPP/START. An 18-member expert panel from academic centers in Ireland and the United Kingdom completed two rounds of the Delphi process by mail survey. Inter-rater reliability was assessed by determining the kappa-statistic for measure of agreement on 100 data-sets.

Results: STOPP is comprised of 65 clinically significant criteria for potentially inappropriate prescribing in older people. Each criterion is accompanied by a concise explanation as to why the prescribing practice is potentially inappropriate. START consists of 22 evidence-based prescribing indicators for commonly encountered diseases in older people. Inter-rater reliability is favorable with a kappa-coefficient of 0.75 for STOPP and 0.68 for START.

Conclusion: STOPP/START is a valid, reliable and comprehensive screening tool that enables the prescribing physician to appraise an older patient's prescription drugs in the context of his/her concurrent diagnoses.

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Abbreviations as Topic
  • Age Factors
  • Aged
  • Analgesics / therapeutic use
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Aspirin / therapeutic use
  • Bendroflumethiazide / therapeutic use
  • Clopidogrel
  • Delphi Technique
  • Digoxin / therapeutic use
  • Digoxin / toxicity
  • Diuretics / therapeutic use
  • Drug Prescriptions / classification
  • Drug Prescriptions / statistics & numerical data*
  • Drug Therapy / standards
  • Drug Therapy / statistics & numerical data
  • Drug Utilization Review / methods*
  • Drug Utilization Review / statistics & numerical data
  • Drug-Related Side Effects and Adverse Reactions
  • Glomerular Filtration Rate / drug effects
  • Health Services for the Aged / organization & administration
  • Health Services for the Aged / statistics & numerical data*
  • Humans
  • Ireland
  • Metformin / therapeutic use
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Reproducibility of Results
  • Risk Factors
  • Ticlopidine / analogs & derivatives
  • Ticlopidine / therapeutic use
  • Time Factors
  • United Kingdom


  • Analgesics
  • Anti-Inflammatory Agents, Non-Steroidal
  • Diuretics
  • Bendroflumethiazide
  • Digoxin
  • Metformin
  • Clopidogrel
  • Ticlopidine
  • Aspirin