Pharmacist-led deprescribing using STOPPFrail for frail older adults in nursing homes

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dc.contributor.authorHurley, Eoin
dc.contributor.authorDalton, Kieran
dc.contributor.authorByrne, Stephen
dc.contributor.authorFoley, Tony
dc.contributor.authorWalsh, Elaine
dc.date.accessioned2026-07-10T14:50:06Z
dc.date.available2026-07-10T14:50:06Z
dc.date.issued2024-07-18
dc.description.abstractObjectives: To evaluate the impact of pharmacist-guided deprescribing using the STOPPFrail (Screening Tool of Older Persons' Prescriptions in Frail adults with a limited life expectancy) criteria in frail older nursing home residents. Design: Prospective, unblinded, non-randomized, intervention study. Setting and Participants: Adults aged ≥65 years with advanced frailty resident in 6 independent nursing homes in Ireland. Methods: STOPPFrail-based deprescribing recommendations were developed by a pharmacist and presented to residents’ general practitioners (GPs), who decided to implement or not. Measured outcomes included number of prescribed medications, medication costs, anticholinergic cognitive burden (ACB), drug burden index (DBI), modified medication appropriateness index (MMAI), quality of life (QoL), non-elective hospitalizations, emergency department visits, falls, and mortality were measured at baseline, post review, and at 6 months post review. Results: Ninety-nine residents were recruited. Most (94%) were prescribed ≥1 potentially inappropriate medication (PIM). The most frequent PIMs were medications without a clearly documented indication (29.6%) and vitamin D (16.9%). Of 348 recommendations provided to GPs, 203 (58%) were accepted and 193 (55%) were implemented. Relating to baseline, post review, and at 6 months: the mean ± standard deviation (SD) number of medications was 16.0 ± 6.1, 14.6 ± 5.7 (P < .001), and 15.4 ± 5.5 (P < .001). The monthly mean ± SD medication cost per patient was €186.8 ± 123.7, €172.7 ± 119.0 (P < .001), and €186.4 ± 121.2 (P = .95). There were significant post-review decreases in the mean DBI, ACB, and MMAI of 9.7%, 9.6%, and 3.7%, respectively (P < .001), which remained significant at 6 months (P < .001). There were no significant differences in falls, emergency department visits, non-elective hospitalizations, or QoL. Conclusions and Implications: STOPPFrail-guided deprescribing led by a pharmacist in nursing homes appeared to significantly reduce PIMs, medication costs (initially), and anticholinergic and sedative burdens, without adversely affecting other patient outcomes. Greater consideration should therefore be given to the wider integration of pharmacists into nursing homes to optimize the medications and health outcomes of frail older adults.en
dc.description.versionPublished Version
dc.format.mimetypeapplication/pdfen
dc.identifier.articleid105122
dc.identifier.authororcidHurley, Eoin
dc.identifier.authororcidDalton, Kieran§0000-0003-1209-8079
dc.identifier.authororcidByrne, Stephen§0000-0003-3141-7004
dc.identifier.authororcidFoley, Tony§0000-0003-3205-3871
dc.identifier.authororcidWalsh, Elaine
dc.identifier.citationHurley, E, Dalton, K, Byrne, S, Foley, T & Walsh, E 2024, 'Pharmacist-led deprescribing using STOPPFrail for frail older adults in nursing homes', Journal of the American Medical Directors Association, vol. 25, no. 9, 105122, pp. 1-7. https://doi.org/10.1016/j.jamda.2024.105122
dc.identifier.doi10.1016/j.jamda.2024.105122
dc.identifier.endpage7
dc.identifier.issn1525-8610
dc.identifier.issued9
dc.identifier.journaltitleJournal of the American Medical Directors Association
dc.identifier.otherORCID: /0000-0003-3141-7004/work/196270901
dc.identifier.otherORCID: /0000-0003-1209-8079/work/196681227
dc.identifier.otherORCID: /0000-0003-3205-3871/work/206002632
dc.identifier.startpage1
dc.identifier.urihttps://hdl.handle.net/10468/19050
dc.identifier.volume25
dc.language.isoen
dc.publisherElsevier Inc.
dc.rights© 2024, the Authors. Published by Elsevier Inc. on behalf of Post-Acute and Long-Term Care Medical Association. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
dc.rights.accessrightsopen access
dc.rights.licensenameAttribution 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.statusPeer reviewed
dc.subjectDeprescribing
dc.subjectNursing home
dc.subjectPharmacist
dc.subjectSTOPPfrail
dc.subject[Pharmacy]
dc.subject[Medicine]
dc.titlePharmacist-led deprescribing using STOPPFrail for frail older adults in nursing homesen
dc.typeArticle (peer-reviewed)
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