Review of STOPP/START, Beers, and FORTA criteria to optimize pharmacotherapy in polymedicated older adults.

Abstract

Introduction: Polypharmacy in older adults is a growing public health problem. This phenomenon brings adverse drug events, frailty, falls, and hospital readmissions. To respond to this challenge, scientists created explicit tools. These tools identify potentially inappropriate prescriptions and also therapeutic omissions.

Objective: This work analyzes the current evidence on the STOPP/START tools, the Beers criteria, and the FORTA list. It also compares their advantages, their limitations, and their possible use in Cuba.

Methods: We conducted a narrative review of the literature published between January 2020 and February 2026. The databases consulted were PubMed, SciELO, Scopus, and Google Scholar. The search combined the terms “STOPP/START”, “Beers criteria”, “FORTA list”, “polypharmacy”, “older adults” and their Spanish equivalents. In the end, we selected 45 original articles, clinical guidelines, and consensus documents.

Development: The STOPP/START criteria (version 3) detect both inappropriate prescriptions and omissions, with high clinical sensitivity. The Beers criteria (2023 update) are very complete and widely cited, but they do not address undertreatment. The FORTA list (2024 version) classifies drugs into four categories (A, B, C, D) according to their benefit-risk balance, which helps with prioritization.

Conclusions: The three tools complement each other. Combined use of them optimizes pharmacotherapy in older adults. In Cuba, systematic implementation is feasible and necessary, although adaptation to resource limitations and the context of primary and secondary care is always needed.