Identification of seniors at risk (ISAR) score and potentially inappropriate prescribing: a retrospective cohort study

Potentially inappropriate prescribing (PIP) is usually associated with a higher risk of adverse health outcomes. It is therefore important to identify PIP in older adults. However, there are no clear prioritisation strategies to select patients requiring prescription reviews.

The aim of this study was to assess the association between the identification of seniors at risk (ISAR) score and the number of PIPs.

A 12-month retrospective hospital-based study was conducted. PIPs, including potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs), were detected using the STOPP/START tool. Multivariate linear regressions were conducted to identify factors associated with the number of PIPs. Sensitivity, specificity, Youden index, and ROC curve were calculated to determine the predictive power of ISAR score.

This study included 266 records. The analysis led to the detection of 420 PIMs and 210 PPOs, with a prevalence of 80.1% and 54.9%, respectively. Multivariate linear regression revealed that the ISAR score (p = 0.041), and the number of medications (p < 0.001) were determinants of PIP. The number of medications remained the sole determinant of the number of PIMs (p < 0.001), while living in a nursing home was the only determinant of the number of PPOs (p = 0.036).

The study showed that the ISAR score and the number of medications were independently associated with the number of PIPs. Considering the use of the ISAR score and the number of medications may be useful strategies to prioritise patients for whom prescribing appropriateness should be assessed using explicit criteria.