Comments from the authors :

 

STOPP-Frail is an explicit list of 27 PIMs in frail older adults with limited life expectancy.

The criteria are not designed to replace clinical judgement, but rather to assist clinicians with medication reviews and assessment of treatment goals in this specific patient cohort.

 

Recognition of those patients to whom STOPP-Frail is applicable may be challenging for less experienced physicians; in these circumstances, the use of simple mortality predictive tools may be helpful to guide life expectancy, However, we anticipate that the majority of clinicians who will use this tool will be experienced in recognising patients who are appropriate for its application, i.e. GPs or senior hospital specialists with prognostic knowledge of the diseases they manage. In the interest of simplicity and for the tool to be user friendly, we did not want STOPP-Frail to be contingent on the use of another tool to determine eligibility.

 

Polypharmacy is a well-described problem in this cohort. This research aims to put a framework on the guiding principle of deprescribing in late life, i.e. that the benefits of many preventive medications are negligible in those with a limited life expectancy.

 

Although many IP explicit tools exist, there has been an unmet need for a concise explicit tool to assist deprescribing in this specific patient cohort. STOPPFrail is a short tool, focusing on 27 key indicators, suggesting that it will be easy to use, time efficient and therefore more likely to be implemented.

Like STOPP/START criteria [23], STOPP-Frail criteria are listed according to physiological system, thereby allowing users to structure their approach to deprescribing.

We aimed for a concise set of criteria that can be easily deployed in paper and electronic format.

 

Developing this tool required discussing many controversial treatments, e.g. those used in the treatment of hypertension.

The authors and panellists agreed that a generalised statement about discontinuing all anti-hypertensives would be
contentious.

Therefore, it was decided to focus on the drug class least likely to be prescribed as a first line agent and most likely to cause orthostatic hypotension and falls in an older cohort, i.e. alpha-blockers.

 

Finally, appropriate use of STOPP-Frail criteria may have pharmaco-economic benefits.

Older frail adults with a poor survival prognosis account for a growing proportion of the population and a disproportionately high level of medication consumption. Implementation of safe, evidence-based deprescribing in this population, may improve patients’ quality of life through reduced ADEs, related hospitalisations and mortality.

 

Key points

• STOPP-Frail comprises 27 criteria for potentially inappropriate medications in frail older adults with limited life expectancy.

• STOPPFrail may serve to assist physicians in deprescribing medications in a structured fashion in this group.

• STOPPFrail can be applied in frail older adults with limited life expectancy in any healthcare setting.