Ability to detect potentially inappropriate prescribing in older patients: comparative analysis between PIM-Check and STOPP/STARTv2.

PURPOSE: Potentially inappropriate prescribing (PIP) is a source of preventable adverse drug events. The objective of this study was a comparative analysis (quantitative and qualitative) between two tools used to detect PIP, PIM-Check and STOPP/START. METHODS: First, a qualitative analysis (QAC) was conducted to evaluate the concordance between the criteria, which constitute PIM-Check and the gold standard STOPP/START. Second, a retrospective comparative and observational study was performed on the list of treatment at the admission of 50 older patients hospitalized in an acute geriatric ward of a university hospital in Switzerland in 2016 using both tools. RESULTS: The QAC has shown that 50% (57 criteria) of STOPP/START criteria are fully or partially concordant with those of PIM-Check. The retrospective study was performed on 50 patients aged 87 years, suffering from 5 co-morbidities (min-max 1-11) and treated by of 8 drugs (min-max 2-16), as medians. The prevalence of the detected PIP was 80% by PIM-Check and 90% by STOPP/START. Medication review shows that 4.2 PIP per patient were detected by PIM-Check and 3.5 PIP by STOPP/START among which 1.9 PIP was commonly detected by both tools, as means. PIM-Check detected more PIP related to cardiology, angiology, nephrology, and endocrinology in older patients but missed the PIP related to geriatric syndromes (e.g., fall, dementia, Alzheimer) detected by STOPP/START. CONCLUSIONS: By using PIM-Check in geriatric settings, some PIP will not be detected. It is considered as a limitation for this tool in this frail population but brings a certain complementarity in other areas of therapy not covered by STOPP/START.

Statin (mis)use in older people: A cross-sectional study using French health insurance databases.

PURPOSE: To describe the occurrence of potential statin misuse, its characteristics and associated factors in older people. METHODS: A retrospective cross-sectional study was conducted in Alsace and Lorraine (France) using French health insurance databases. Study population comprised community-dwelling patients and nursing homes residents aged 80 and over, who received at least one statin prescription between January 1, 2017 to April 30, 2017 (N = 38 268). Potential statin misuse was identified considering off-label uses, high-intensity doses, drug contraindications and statin-drug interactions. RESULTS: At least one potential statin misuse was detected for 19 468 patients (50.9%). Off-label prescription was the most frequent misuse observed (53.6%), followed by high-intensity statin dose (30.5%). Polypharmacy (five to nine drugs) and excessive polypharmacy (10 or more drugs) were the main risk factors associated with potential statin misuse (adjusted OR = 2.6 and 4.7 respectively). Nursing home, multi-morbidity and the presence of multiple prescriptions from different doctors for the same patient were other risk factors significantly associated. Two sensitivity analyzes (reconsiderations of off-label and high statin dose definitions) revealed the same statistical trend. CONCLUSION: Potential statin misuse is frequent in people aged 80 and over. These findings should serve as a warning to health care professionals and hopefully will contribute to ensure an appropriate and safe use of statin in aged population.

Vaccination for quality of life: herpes-zoster vaccines.

Current vaccination policy in most high-income countries aims to counteract the decline in cell-mediated immunity to varicella zoster virus that occurs with advancing age or immunosuppression. The aim of this review was to describe the burden of illness associated with herpes zoster (HZ) and post-herpetic neuralgia (PHN) risks and their impact on the social and common life in infected people. The effectiveness/efficacy and cost effectiveness of the immunization strategy will be presented through the review of the literature relevant to the live attenuated HZ vaccine (ZLV) licensed in 2006 and the recombinant HZ vaccine (RZV). The latter has very recently been approved to protect aged people aged ≥ 50 years against HZ morbidity including its complications, and associated health-care costs. Finally, this review also provides data with respect of precautions of using and safety of ZVL and RVZ.

Effect of high-intensity interval training and continuous endurance training on peak oxygen uptake among seniors aged 65 or older: A meta-analysis of randomized controlled trials.

BACKGROUND: Ageing is intrinsically associated with a progressive decline in cardiorespiratory fitness (CRF) as measured by peak oxygen uptake (VO2peak ). Improving CRF through physical activity contribute to better and healthy ageing. High-intensity interval training (HIIT) is a potent method of improving CRF among seniors, yet comparisons between this type of training and traditional endurance training (ET) are equivocal especially among older adults. PURPOSE: To analyse the effects of HIIT and ET on the VO2peak of seniors aged 65 years or older when compared with controls and also when the two types of training were compared with one another. METHODS: A comprehensive, systematic database search for manuscripts was performed in Embase, Medline, PubMed Central, ScienceDirect, Scopus and Web of Science using key words. Two reviewers independently assessed interventional studies for potential inclusion. Fifteen randomized controlled trials (RCTs) were included totalling 480 seniors aged 65 years or over. Across the trials, no high risk of bias was measured. RESULTS: In pooled analysis of the RCTs, the VO2peak was significantly higher after ET sessions compared with controls (mean difference-MD = 1.35; 95% confidence interval-CI: 0.73-1.96). Furthermore, VO2peak was found significantly higher not only when compared HIIT with controls (MD = 4.61; 95% CI: 3.21-6.01), but also when compared HIIT with ET (MD = 3.76; 95% CI: 2.96-4.56). CONCLUSION: High-intensity interval training and ET both elicit large improvements in the VO2peak of older adults aged 65 or over. When compared with ET, the gain in VO2peak was greater following HIIT. Nevertheless, further RCTs are therefore needed to confirm our results in senior's population.

Effects of a short-term Interval Aerobic Training Programme with active Recovery bouts (IATP-R) on cognitive and mental health, functional performance and quality of life: A randomised controlled trial in sedentary seniors.

BACKGROUND: Interval aerobic training programme with active recovery bouts (IATP-R) has shown to improve tolerance to IATP among seniors. However, data concerning its benefits for seniors' health are still limited. PURPOSE: The purpose of this study was to examine the effects of IATP-R on seniors' health status. METHODS: Sedentary volunteers (n = 60, aged ≥70 years) were randomly assigned to either IATP-R or maintained sedentary lifestyle for 9.5 weeks. IATP-R consisted of 30-minute cycling (6 × 4 minutes at first ventilatory threshold (VT1 ) intensity + 1 minute at 40% of VT1 ) twice a week. Cognitive and functional performances were assessed with the Trail Making Test (TMT-A; TMT-B); Paced Auditory Serial Addition Test (PASAT); Timed Up and Go (TUG) test; 6-Minute Walk Test (6-MWT); one-leg balance test; and the Short Physical Performance Battery (SPPB) tests, respectively. QoL and anxiety/depression status were measured by the Short Form-12 and the Goldberg's Scale, respectively. All participants were assessed at baseline and 9.5 weeks later. RESULTS: Compared to controls, IATP-R improved cognitive functions (TMT-A: +1.5% vs -21.5%; TMT-B: +0.9% vs -13.3%; PASAT: +1.4% vs -14.6%; semantic fluency: -1.1% vs +11.7%), functional performance (TUG: +5.4% vs -16.5%; 6-MWT: -3.2% vs +11.5%; SPPB: -3.2% vs +14.6%; One-leg balance: -16.3% vs +25.0%); QoL (physical health: -13.3% vs +23.1%; mental health: -7.1% vs +8.2%); and depressive symptoms (+26.3% vs -42.8%). Significant impacts were measured neither on letter modality of fluency tasks nor on anxiety score. CONCLUSION: These data showed that IATP-R is an effective training programme to improve functional and cognitive performances, mental health and well-being in sedentary seniors. Trial registration ClinicalTrials.gov NCT02263573. Registered October 1, 2014.

Interventions to restore appropriate immune function in the elderly.

Advanced age is one indicator of likely immune dysfunction. As worldwide, the global population contains progressively more and more older individuals there is likelihood of an increased prevalence and incidence of infectious diseases due to common and emergent pathogens. The resultant increase in mortality and morbidity would be matched by the risk of functional decline and disability. Maintaining immune function at a plateau throughout life may therefore be associated with considerable cost savings. The aim of improving immune function in older individuals may be achieved through considering a therapeutic approach to rejuvenate, stimulate or support the indigenous immune system to perform in a more optimal manner. In terms of cost effectiveness a therapeutic approach may prove difficult because of issues associated with; identifying those who would benefit the most from this treatment, identifying the type of treatment which would suit them and identifying whether the treatment was successful. The alternative of supporting or providing a stronger stimulus through vaccination, whilst more cost effective, may be a more valuable option in the short term. Both approaches will be addressed in this review.

Effects of Interval Aerobic Training Program with Recovery bouts on cardiorespiratory and endurance fitness in seniors.

Interval aerobic training programs (IATP) improve cardiorespiratory and endurance parameters. They are, however, unsuitable to seniors as frequently associated with occurrence of exhaustion and muscle pain. The purpose of this study was to measure the benefits of an IATP designed with recovery bouts (IATP-R) in terms of cardiorespiratory and endurance parameters and its acceptability among seniors (≥70 years). Sedentary healthy volunteers were randomly assigned either to IATP-R or sedentary lifestyle. All participants performed an incremental cycle exercise and 6-minute walk test (6-MWT) at baseline and 9.5 weeks later. The first ventilatory threshold (VT1 ); maximal tolerated power (MTP); peak of oxygen uptake (VO2peak ); maximal heart rate (HRmax ); and distance walked at 6-MWT were thus measured. IATP-R consisted of 19 sessions of 30-minute (6 × 4-min at VT1  + 1-minute at 40% of VT1 ) cycling exercise over 9.5 weeks. With an adherence rate of 94.7% without any significant adverse events, 9.5 weeks of IATP-R, compared to controls, enhanced endurance (VT1 : +18.3 vs -4.6%; HR at baseline VT1 : -5.9 vs +0.2%) and cardiorespiratory parameters (VO2peak : +14.1 vs -2.7%; HRmax : +1.6 vs -1.7%; MTP: +19.2 vs -2.3%). The walk distance at the 6-MWT was also significantly lengthened (+11.6 vs. -3.1%). While these findings resulted from an interim analysis planned when 30 volunteers were enrolled in both groups, IATP-R appeared as effective, safe, and applicable among sedentary healthy seniors. These characteristics are decisive for exercise training prescription and adherence.

[Geriatric medicine]. / Gériatrie.

2017 highlights benefits of prevention. Better control of cardiovascular risk reduces the incidence of dementia and monthly high-dose vitamin D the incidence of respiratory infections in nursing home. Pre-operative geriatric assessment lowers by 20% the rate of delirium after hip-fracture surgery and complications in vascular surgery. Deleterious effects are also reported. High-dose vitamin D triples the rate of falls in supplemented residents and doesn't improve gait speed in sedentary men. Widely used in cardiovascular prevention, antithrombotic therapy is associated with an astonishing risk of subdural bleeding that further increases with the number of drugs combined together. Finally, the non-pharmacological management of behavioral and psychotic symptoms in advanced dementia, although effective, doesn't reduce the associated burden for proxies.

2017, année de la prévention. Un meilleur contrôle des facteurs de risque cardiovasculaires réduit l'incidence de la démence et des fortes doses mensuelles de vitamine D diminuent l'incidence des infections respiratoires en EMS. L'évaluation gériatrique préopératoire diminue de 20% le taux de confusion postopératoire après chirurgie d'une fracture du col fémoral et de complications précoces en chirurgie vasculaire. De hautes doses de vitamine D multiplient par 3 le risque de chutes chez des résidents vivant en institution et n'améliorent pas la vitesse de marche chez des hommes sédentaires. Très utilisés en prévention cardiovasculaire les médicaments antithrombotiques sont associés à un risque élevé d'hématomes sous-duraux. Ce risque augmente avec le nombre de médicaments prescrits. Enfin, le traitement non pharmacologique des troubles psycho-comportementaux dans les démences avancées réduit l'intensité des troubles et aussi le fardeau des aidants.

[Which alternative to benzodiazepines, Z-pills and other hypnotics for aged people ? Melatonin, valerian, or clomethiazole]. / Quelle alternative aux benzodiazépines, Z-pills et autres hypnotiques pour les personnes âgées ?: Mélatonine, valériane ou clométhiazole.

Sleep disorders are a recurrent complaint in geriatrics. Of multifactorial origin, they have a significant impact on health and quality of life. However, the answer is (too) often the prescription of benzodiazepines or related-drugs (Z-pills), sedative antidepressant, or another psychotropic medication. More recently, melatonin, valerian and, in Switzerland, clomethiazol are widely considered as effective and more suitable alternatives for aged people. We present a systematic review of the literature on the efficacy and tolerance of these molecules, of which the main objective is to demonstrate that non-pharmacological approach must remain the first-line therapy of insomnia in geriatrics.

Les troubles du sommeil sont une plainte récurrente en gériatrie. D'origine multifactorielle, ils ont un retentissement significatif sur la santé et la qualité de vie. Cependant la réponse est (trop) souvent la prescription de benzodiazépines ou apparentés (Z-pills), d'un antidépresseur sédatif ou d'un autre psychotrope. Plus récemment, la mélatonine, la valériane et, en Suisse, le clométhiazole sont largement utilisés car considérés comme des alternatives efficaces et plus adaptées aux personnes âgées. Nous présentons une revue systématique de la littérature sur l'efficacité et la tolérance de ces molécules dont l'objectif principal est de montrer que les mesures non pharmacologiques doivent rester le traitement de première intention des insomnies en gériatrie.

[Detecting and assessing the impactof anticholinergic medications]. / Détecter et évaluer l'impact desmédicaments anticholinergiques.

Limitation of inappropriate prescribing must be a medical concern in daily practice especially in older patients. In particular, anti-cholinergic drugs (anti-ACh), which are not all explicitly classified as anti-ACh, are commonly prescribed for a wide range of indications (pulmonary obstructive diseases, anxiety, insomnia, urinary incontinence, Parkinson's disease, congestive heart failure). Their prescription is however associated with a reduced quality of life and increased morbidity and mortality. Tools detecting inappropriate prescriptions and clinical scales that quantify the anti-ACh burden contribute, despite some limitations, to secure and optimize these drugs' prescription in this vulnerable population.

Réduire les prescriptions inappropriées doit être une préoccu-pation médicale du quotidien, notamment chez les patients les plus âgés. Plus particulièrement, les médicaments à effet anticholinergique (anti-ACh), qui ne sont pas tous classés comme anti-ACh, sont largement prescrits pour des indications très diverses (pathologies obstructives pulmonaires, anxiété, insomnie, incontinence urinaire, maladie de Parkinson, insuffisance cardiaque congestive). Leur prescription est cependant associée à une altération de la qualité de vie, et une augmentation de la morbi-mortalité.Les outils de détection des prescriptions inappropriées et les échelles cliniques quantifiant le fardeau anti-ACh contribuent à sécuriser et à optimiser, malgré certaines limitations, la prescription de ces molécules dans cette population vulnérable.

[Geriatric medicine]. / Gériatrie.

In 2016, consequences, contributing factors, and prevention of inappropriate drug prescribing were investigated. Two studies lift the veil on unexplained falls and syncope. A meta-analysis questions the need to adapting transfusion's threshold to comorbidities, and another one the performance of screening for swallowing disorders. The Framingham Heart Study reports the declining of the incidence of vascular dementia. The role played by microbleeds in cognitive deterioration was investigated and aducanumab showed encouraging effect in Alzheimer's disease. When vaccination against influenza for health workers in nursing home was challenged by a meta-analysis this recommendation must be followed. Vaccines against shingles are effective and safe, and a study confirms the efficacy of the HZ7su among 70+.

En 2016, les conséquences, les facteurs favorisants et la prévention des prescriptions médicamenteuses inappropriées ont été étudiés. Deux études lèvent le voile sur les chutes inexpliquées et les syncopes. Une méta-analyse questionne sur l'adaptation du seuil transfusionnel aux comorbidités et une autre le dépistage des troubles de la déglutition. L'étude de Framingham rapporte la diminution de l'incidence des démences vasculaires. Le rôle joué par les microbleeds dans la détérioration cognitive a été exploré et l'aducanumab montre des effets encourageant dans la maladie d'Alzheimer. Si la vaccination contre la grippe du personnel d'EMS est remise en question par une méta-analyse, cette recommandation doit être respectée. Les vaccins contre le zona sont efficaces et sûrs et une étude confirme l'efficacité du HZ / su chez les plus de 70 ans.

[Nocturia in aged patient: in practice]. / Nycturie du patient âgé : en pratique.

Nocturia is defined as the complaint that the individual has to wake at night to urinate. In older persons, this urinary functional disorder is most often of multifactorial origin and/or the symptom (sometimes the unique one) of a chronic disease. Nocturia is very annoying and its impact on health and quality of life is related to the disturbance of sleep cycles. In aged patients, who are often polymorbide and polymedicated, the interaction between nocturia and geriatric syndromes as well as comorbidities has to be more particularly underlined. The impact on informal caregiver's health and the decision for institutional admission are also to be considered. An adapted management of nocturia improves quality of life and reduces morbidity in aged patients.

La nycturie se définit comme la plainte d'avoir à se réveiller la nuit en raison d'une envie d'uriner. Chez les personnes âgées, ce trouble urinaire est le plus souvent d'origine multifactorielle et/ou le symptôme (parfois même unique) d'une maladie chronique. La nycturie est très gênante, et son impact sur la santé et la qualité de vie est lié à la perturbation du cycle de sommeil. Chez le patient âgé, souvent polypathologique et polymédiqué, l'interaction de la nycturie avec les syndromes gériatriques et les comorbidités doit être plus particulièrement soulignée. L'impact sur la santé du proche aidant et la décision d'une entrée en institution sont aussi à considérer. Une prise en charge adaptée de la nycturie améliore la qualité de vie et réduit la morbidité chez les patients âgés.

[The 'physical aptitude for health consultation' in a geriatric unit]. / La consultation de l'aptitude physique pour la santé dans un pôle de gériatrie.

The aim of the 'physical aptitude for health consultation' is to offer a validated physical reconditioning programme to adults with a stabilised chronic condition. It notably enables the absence of any contraindications to be established. A first of its kind in France, the programme has been implemented at Strasbourg university hospital.

[Geriatry]. / Gériatrie.

n 2015, several studies about hypertension and TAVI emphasize the importance of individualizing treatment goals in very old or vulnerable patients. The anti-pneumococcal conjugate vaccine has demonstrated its effectiveness in community-acquired pneumonia and the arsenal against shingles is extended by a subunit vaccine. A clinical trial confirms the ineffectiveness of testosterone supplementation in arteriosclerotic disease but not its safety. Regarding dementia, a rigorous study shows that a multimodal approach can reduce the risk of cognitive decline. The value of imaging technologies using Tau protein radiotracers is confirmed for monitoring the evolution of Alzheimer's disease and the latest studies about anti-amyloid vaccines finally demonstrate encouraging results.

Dose response kinetics of CD8 lymphocytes from young animals transfused into old animals and challenged with influenza.

Transfusion of autologous leukocytes after prolonged storage has been proposed as a means of rejuvenating the immune system of older individuals. The rationale for this approach is that age related immune decline is associated with a diminished pool of naïve T cells following atrophy of the thymus and reduction in thymic output. The presence of high levels of naïve T cells within the blood of young individuals could provide a boost to the immune system of an older "self" through a rejuvenation of the naïve T cell pool. However what remains unresolved is whether the cells could be incorporated effectively into the T cell pool of the host and whether effectors could be generated. Using CD45 congenic mice in our experiments we show that the transfusion of young donor cells into older congenic host animals leads to their successful incorporation into the peripheral T cell pool. When the recipients were challenged with influenza virus, specific effector CD8 cells were generated which were of both host and donor origin. We found no relationship between the number of responder cells of donor origin at the time of assay and the number of cells injected.

The Hospital Anxiety and Depression Scale: low sensitivity for depression screening in demented and non-demented hospitalized elderly.

BACKGROUND: We currently use the depression subscale (HADD) of the Hospital Anxiety and Depression Scale (HADS) for depression screening in elderly inpatients. Given recent concerns about the performance of the HADD in this age group, we performed a quality-control study retrospectively comparing HADD with the diagnosis of depression by a psychiatrist. We also studied the effect of dementia on the scale's performance. METHODS: HADS produces two 7-item subscales assessing depression or anxiety. The HADD was administered by a neuropsychologist. As "gold standard" we considered the psychiatrist's diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. Patients older than 65 years, assessed by both the HADD and the psychiatrist, with a clinical dementia rating (CDR) score lower than 3, were included. The effect of dementia was assessed by forming three groups according to the CDR score (CDR0-0.5, CDR1, and CDR2). Simple and multiple logistic regression models were applied to predict the psychiatrist's depression diagnosis from HADD scores. Areas under the receiver operating characteristics curve (AUC) were plotted and compared by χ(2) tests. RESULTS: On both univariate and multiple analyses, HADD predicted depression diagnosis but performed poorly (univariate: p = 0.009, AUC = 0.60 (95% confidence interval (CI) = 0.53-0.66); multiple: p = 0.007, AUC = 0.65 (95% CI = 0.58-0.71)), regardless of cognitive status. Because mood could have changed between the two assessments (they occurred at different points of the hospital stay), the multiple analyses were repeated after limiting time interval at 28, 21, and 14 days. No major improvements were noted. CONCLUSION: The HADD performed poorly in elderly inpatients regardless of cognitive status. It cannot be recommended in this population for depression screening without further study.

Impact of an early geriatric rehabilitation program in acutely hospitalised vulnerable patients: a real-life study in an ACE unit in Switzerland.

INTRODUCTION: Early geriatric rehabilitation programs are potential means to prevent acute hospitalisation-associated functional decline. METHODS: The objectives were to measure the impact of an interdisciplinary rehabilitation program on patients' administrative in hospital data and on functional trajectories. With a before-and-after design, we compared all patients admitted from January to August 2018 into the Acute Care for Elders (ACE) unit of an Academic hospital in Switzerland who received this type of program to those admitted during the same period in 2016 and 2017. We considered vulnerable patients aged 75 or older. Functional independency level was assessed at baseline, admission, and discharge according to Katz's basic activities daily living (BADL). RESULTS: In total, 378/1,073 patients (mean age 86.6 ± 6.4; 74.6% women; 84% admitted from the emergency department) were prospectively admitted into the ACE unit in 2018. With an adherence rate of 74.0% to functional therapies and compared to the prior years, the program reduced transfers to rehabilitation settings (28.5 vs. 24.3%, p=0.04) and increased direct discharges to home (46.8 vs. 42.4%, p=0.04). Rates of early-unplanned readmission were similar. Between admission to discharge, 89.9% of the patients engaged in the program remained functionally stable or enhanced. Whatever the BADL score at the admission, 46.5% improved their status for at least one BADL. Even though no clinical determinant was identified, patients who engaged ≥ 5 sessions of functional therapy per week were more likely to improve their functional level (OR = 3.05; 95% CI 1.76-5.27). CONCLUSION: This real-life study demonstrates arguments to implement early interdisciplinary rehabilitation program in ACE units in particular to prevent functional decline in vulnerable patients. These findings support consideration regarding the interest of switching from the traditional disease-centred approach in acute care for older patients to a modern one, that also put the emphasis on maintaining functional capacities.

[Acute and postherpetic neuralgia in the elderly: analysis of evidence for therapeutic options]. / Douteurs zostériennes et post- zostériennes chez la personne âgée: analyse des évidences pour une prise en charge adaptée.

Initiated within the first 72 hours of the rash, the aim of antiviral drugs prescribing is to reduce both acute neuralgia (AN) and later complications and especially postherpetic neuralgia (PHN). However their analgesic as well as preventative effect on AN and PHN is modest. With the lack of the preventive vaccine in Switzerland and in the absence of more effective antiviral drugs, combinations with analgesic drugs are often needed in pain management. However medication selection and prescribed dosage in the context of old patients' frailty, co-morbidities and often polypharmacy must be carefully considered. Based on analysing the evidences from the literature, this review presents the therapeutic options we have at one's disposal and proposes a stepwise management for both AN and PHN specifically designed for aged population.

[The impact of medication on vitamins and trace elements]. / Statut en vitamines et en oligoéléments: impact des médicaments.

Epidemiological studies have shown that vitamin or trace-element deficiencies are frequent in the general population. Food intake can be incriminated, but various drugs may also precipitate micronutrient deficits. Indeed, the consequences of pharmacotherapy on micronutrients are yet modestly explored in clinical practice settings. We aim at sensitizing physicians on the impact of frequently used drugs on vitamins and trace-elements. High risk populations for micronutrient deficiencies and indications for substitution are discussed.

Impact of Pharmaceutical Interventions with STOPP/START and PIM-Check in Older Hospitalized Patients: A Randomized Controlled Trial.

INTRODUCTION: Pharmaceutical interventions can reduce negative outcomes related to potentially inappropriate prescriptions (PIPs). OBJECTIVE: The objective of this study was to compare the impact of interventions on the reduction of PIPs and on different clinical outcomes using two electronic explicit tools. METHODS: A randomized controlled trial was conducted in patients hospitalized between 2018 and 2019 at the Acute Care for Elders unit at Lausanne University Hospital in Switzerland. A medication review was conducted using PIM-Check in the first arm and STOPP/START in the second arm. Proposed interventions were communicated to the physicians. Clinical outcomes evaluated were incidence of falls, delirium, activities of daily living (ADL), length of stay, number of drugs at discharge and hospital readmission. RESULTS: The 123 included patients (60 in the first arm and 63 in the second arm) were 86.3 ± 6.6 years old, had 3.5 ± 1.7 diseases and were treated by 6.2 ± 2.7 drugs at admission. There was a significant decrease in PIPs in each arm, but no significant difference between arms. The deprescription of nervous system drugs was significantly higher with STOPP/START than with PIM-Check (Chi-square p = 0.025). ADL scores between home and discharge were significantly higher in the STOPP/START arm than in the PIM-Check arm (4.42 vs 3.77; p = 0.040). The predictors of ADL score improvement were the deprescription of nervous system drugs (ß = 0.423; 95% CI 0.034-0.812; p = 0.033), the use of STOPP/START (ß = 0.798, 95% CI 0.305-1.290; p = 0.002) and a shorter length of hospital stay (ß = -0.033, 95% CI - 0.056 to - 0.010; p = 0.005). CONCLUSIONS: Although PIM-Check was non-inferior to STOPP/START in reducing the number of PIPs, STOPP/START had a significantly higher impact on ADL. The use of STOPP/START or the deprescription of two nervous system drugs would allow the patient to acquire almost one more basic function of living. On the other hand, a loss of one point on the ADL score was observed per month of hospitalization. CLINICAL TRIALS REGISTRATION NUMBER: NCT04028583.