Clinical utilization of Beers Criteria and STOPP-START algorithm in elderly patients: emphasis on neuropsychiatric medications

Abstract

Polypharmacy (the chronic concurrent use of five or more pharmaceutical agents) is independently associated with Adverse Drug Events (ADEs), functional decline, and mortality in older adults. Age-related physiological changes-including impaired renal and hepatic clearance, increased volume of drug distribution, and heightened pharmacodynamic sensitivity-substantially amplify the risk of medication-related harm in geriatric populations. The likelihood of developing an ADE increases proportionally with the number of drugs prescribed, irrespective of patient age or comorbidity burden, and parallels rates of hospitalization and functional deterioration. Neuropsychiatric medications-including benzodiazepines, antipsychotics, antidepressants, and mood stabilizers-are disproportionately implicated in falls, delirium, cognitive impairment, cerebrovascular events, and excess mortality. Measures to improve clinician awareness of rational neuropsychiatric prescribing across primary, specialist, and acute care settings are therefore a priority in geriatric medicine. Various explicit prescribing tools have been developed to identify Potentially Inappropriate Prescribing (PIP). Among these, the American Geriatrics Society Beers Criteria and the European STOPP-START algorithm are the most widely validated and adopted. This review provides a structured, evidence-based analysis of these tools, with emphasis on polypharmacy burden, PIP epidemiology, deprescribing frameworks, multidisciplinary decision-making, and the specific mechanistic and clinical risks associated with geriatric neuropsychiatric medications.