STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk): a Delphi study by the EuGMS Task and Finish Group on Fall-Risk-Increasing Drugs

Abstract

Background Healthcare professionals are often reluctant to deprescribe fall-risk-increasing drugs (FRIDs). Lack of knowledge and skills form a significant barrier and furthermore, there is no consensus on which medications are considered as FRIDs despite several systematic reviews. To support clinicians in the management of FRIDs and to facilitate the deprescribing process, STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk) and a deprescribing tool were developed by a European expert group. Methods STOPPFall was created by two facilitators based on evidence from recent meta-analyses and national fall prevention guidelines in Europe. Twenty-four panellists chose their level of agreement on a Likert scale with the items in the STOPPFall in three Delphi panel rounds. A threshold of 70% was selected for consensus a priori. The panellists were asked whether some agents are more fall-risk-increasing than others within the same pharmacological class. In an additional questionnaire, panellists were asked in which cases deprescribing of FRIDs should be considered and how it should be performed. Results The panellists agreed on 14 medication classes to be included in the STOPPFall. They were mostly psychotropic medications. The panellists indicated 18 differences between pharmacological subclasses with regard to fall-risk-increasing properties. Practical deprescribing guidance was developed for STOPPFall medication classes. Conclusion STOPPFall was created using an expert Delphi consensus process and combined with a practical deprescribing tool designed to optimise medication review. The effectiveness of these tools in falls prevention should be further evaluated in intervention studies.

A Propensity Score Matched Approach to Assess the Associations of Commonly Prescribed Medications with Fall Risk in a Large Harmonized Cohort of Older Ambulatory Persons

“…Furthermore, β-blocker users had a lower fall risk in our cross-sectional analysis (OR 0.86 [0.79-0.95]) in line with the meta-analysis of adjusted data (OR 0.88 [0.80-0.97], 8 studies) [8]. Finally, proton pump inhibitor use was associated with a higher risk only in a cross-sectional analysis and it should be noted that the vast majority of the European expert panel did not considered proton pump inhibitors to increase fall risk in a consensus effort [35]. This indicates that the found association might be explained by the residual confounding.…”

Hip Fracture Risk in Antiepileptic Drug Initiators and Non-Initiators with Alzheimer’s Disease

“…In persons with AD, AEDs are mainly used for central neuropathic pain, 6 and neuropsychiatric symptoms of cognitive disorders (eg, agitation and aggression), 7 although, particularly in the case of neuropathic pain, this goes against recent recommendations due to an increased risk of falls. 8 Moreover, in a recent systematic review of randomized controlled trials, valproate showed no benefit in treating dementia-related agitation and a high rate of adverse effects, including sedation was observed among valproate users. 9 Still, the risk-benefit profile of most AEDs in persons with AD is still largely unclear [10][11][12][13] and their adverse effects, including effects on cognition are of concern, given that cognitive status is already impaired due to AD itself.…”

A scoping review of the changing landscape of geriatric medicine in undergraduate medical education: curricula, topics and teaching methods

“…Clinicians and medical students have reported limited self-efficacy in deprescribing [ 79 ], warranting further education on deprescribing and deprescribing tools. These include The American Geriatrics Society Choosing Wisely Workgroup’s publications, the updated Beers Criteria®, the FORTA (Fit fOR The Aged) List, the Screening Tool of Older People's Prescriptions and Screening Tool to Alert to Right Treatment (STOPP/START) criteria, and the Screening Tool of Older Persons Prescriptions in older adults with high fall risk (STOPPFall) [ 80 – 85 ]. In our view, the learning outcomes of medical students should include knowledge of deprescribing tools and of age- and frailty-related changing risk management and treatment goals.…”