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Deprescribing in cognitively vulnerable older people: development and validation of STOPPCog criteria
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Date
2025-02-04
Authors
McGettigan, Siobhan
Curtin, Denis
O’Mahony, Denis
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Publisher
Oxford University Press
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Abstract
Objective: To validate STOPPCog, a list of explicit criteria for potentially inappropriate medication use in cognitively vulnerable older adults. Design: A Delphi consensus survey of an expert panel comprising academic geriatricians, old age psychiatrists, general practitioners, and clinical pharmacists.Setting: Ireland. Subjects: Nine panellists. Methods: STOPPCog criteria were initially created by the authors based on clinical experience and literature appraisal. Criteria were organised according to drug/drug class. Using Delphi consensus methodology, panellists ranked their agreement with each criterion on a 5-point Likert scale and provided written feedback. Criteria with a median value of 1 or 2 (strongly agree/agree) and a 25th centile value of ≤2 were included in the final list. Results: All panellists completed two Delphi consensus validation rounds. Twenty-five criteria were proposed initially, twenty were accepted. One criterion was rejected (multi-vitamin supplements), and four criteria were rephrased (two of these were combined to one criterion for greater clarity). The final list comprised 23 criteria that are arranged in six subgroups i.e. (i) drugs with anticholinergic properties taken daily; (ii) drugs with sedative properties taken daily; (iii) drugs that may exacerbate psychotic symptoms in patients with alpha-synuclein pathology; (iv) drugs used for chronic pain; (v) drugs without proven efficacy for dementia taken daily; (vi) drugs that are of no proven benefit in advanced stage dementia i.e. clinical dementia rating of 3.0 where palliation may be appropriate. Conclusion: STOPPCog comprises 23 criteria relating to medications that are potentially inappropriate in cognitively vulnerable older adults. STOPPCog may assist physicians in deprescribing medications in this patient population.
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Keywords
Polypharmacy , Deprescribing , Cognition , Dementia , Potentially inappropriate medication (PIM) , Older people
Citation
McGettigan, S., Curtin, D. and O’Mahony, D. (2025) 'Deprescribing in cognitively vulnerable older people: development and validation of STOPPCog criteria', Age and Ageing, 54(2), afaf014 (7pp). https://doi.org/10.1093/ageing/afaf014
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© 2025, the Authors. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.