dc.contributor.author	Curtin, Denis
dc.contributor.author	Dukelow, Tim
dc.contributor.author	James, Kirstyn
dc.contributor.author	O'Donnell, Desmond
dc.contributor.author	O'Mahony, Denis
dc.contributor.author	Gallagher, Paul F.
dc.contributor.funder	Horizon 2020	en
dc.date.accessioned	2018-11-27T12:18:40Z
dc.date.available	2018-11-27T12:18:40Z
dc.date.issued	2018-11-12
dc.description.abstract	Purpose: Older people with advanced frailty are among the highest consumers of medications. When life expectancy is limited, some of these medications are likely to be inappropriate. The aim of this study was to compare STOPPFrail, a concise, easy-to-use, deprescribing tool based on explicit criteria, with gold standard, systematic geriatrician-led deprescribing. Methods: One hundred standardized clinical cases involving 1024 medications were prepared. Clinical cases were based on anonymized hospitalized patients aged ≥ 65 years, with advanced frailty (Clinical Frailty Scale ≥ 6), receiving ≥ 5 regular medications, who were selected from a recent observational study. Level of agreement between deprescribing methods was measured by Cohen’s kappa coefficient. Sensitivity and positive predictive value of STOPPFrail-guided deprescribing relative to gold standard deprescribing was also measured. Results: Overall, 524 medications (51.2%) of medications prescribed to this frail, elderly cohort were potentially inappropriate by gold standard criteria. STOPPFrail-guided deprescribing led to the identification of 70.2% of the potentially inappropriate medications. Cohen’s kappa was 0.60 (95% confidence interval 0.55–0.65; p < 0.001) indicating moderate agreement between STOPPFrail-guided and gold standard deprescribing. The positive predictive value of STOPPFrail was 89.3% indicating that the great majority of deprescribing decisions aligned with gold standard care. Conclusions: STOPPFrail removes an important barrier to deprescribing by explicitly highlighting circumstances where commonly used medications can be safely deprescribed in older people with advanced frailty. Our results suggest that in multi-morbid older patients with advanced frailty, the use of STOPPFrail criteria to address inappropriate polypharmacy may be reasonable alternative to specialist medication review.	en
dc.description.status	Peer reviewed	en
dc.description.version	Accepted Version	en
dc.format.mimetype	application/pdf	en
dc.identifier.citation	Curtin, D., Dukelow, T., James, K., O’Donnell, D., O’Mahony, D. and Gallagher, P. (2018) ‘Deprescribing in multi-morbid older people with polypharmacy: agreement between STOPPFrail explicit criteria and gold standard deprescribing using 100 standardized clinical cases’, European Journal of Clinical Pharmacology. doi: 10.1007/s00228-018-2598-y	en
dc.identifier.doi	10.1007/s00228-018-2598-y
dc.identifier.issn	0031-6970
dc.identifier.issn	1432-1041
dc.identifier.journaltitle	European Journal of Clinical Pharmacology	en
dc.identifier.uri	https://hdl.handle.net/10468/7152
dc.language.iso	en	en
dc.publisher	Springer Nature Switzerland AG	en
dc.relation.project	info:eu-repo/grantAgreement/EC/H2020::RIA/634238/EU/OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly/OPERAM	en
dc.rights	© 2018, Springer-Verlag GmbH Germany, part of Springer Nature. All rights reserved. The final publication is available at Springer via https://dx.doi.org/10.1007/s00228-018-2598-y	en
dc.subject	STOPPFrail	en
dc.subject	Deprescribing	en
dc.subject	Frailty	en
dc.subject	Polypharmacy	en
dc.subject	Multi-morbidity	en
dc.title	Deprescribing in multi-morbid older people with polypharmacy: agreement between STOPPFrail explicit criteria and gold standard deprescribing using 100 standardized clinical cases	en
dc.type	Article (peer-reviewed)	en

Deprescribing in multi-morbid older people with polypharmacy: agreement between STOPPFrail explicit criteria and gold standard deprescribing using 100 standardized clinical cases

Files

Original bundle

License bundle

Collections