STOPPFrail (Screening Tool of Older Persons’ Prescriptions in Frail adults with a limited life expectancy) criteria: application to a representative population awaiting long-term nursing care

• Published in: European journal of clinical pharmacology Vol. 75; no. 5; pp. 723 - 731
• Main Authors: Lavan, Amanda Hanora, O’Mahony, Denis, Gallagher, Paul
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-05-2019; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Biomedical and Life Sciences; Biomedicine; Cognitive ability; Cohort Studies; Criteria; Female; Frail Elderly - statistics & numerical data; Humans; Inappropriate Prescribing - statistics & numerical data; Ireland - epidemiology; Life Expectancy; Life span; Long-term care; Male; Medical prognosis; Medical screening; Nursing care; Nursing Homes; Older people; Pharmacoepidemiology and Prescription; Pharmacology/Toxicology; Potentially Inappropriate Medication List - standards; Potentially Inappropriate Medication List - statistics & numerical data; Proton pump inhibitors; Retrospective Studies; Risk factors; Statins; Ireland; STOPPFrail criteria; Poor survival prognosis; Older people; Potentially inappropriate medications; Explicit criteria
• ISSN: 0031-6970; 1432-1041
• DOI: 10.1007/s00228-019-02630-3

Purpose
STOPPFrail criteria highlight instances of potentially inappropriate medications (PIMs) in frailer older adults with poor 1-year survival prognosis. The objectives of this study were to (i) determine the proportion of older adults requiring long-term nursing care in whom STOPPFrail criteria are applicable, (ii) measure the prevalence of STOPPFrail PIMs, and (iii) identify risk factors for PIMs in this cohort.
Methods
We retrospectively reviewed applications for long-term nursing care to nursing homes in the Cork area over a 6-month period. We recorded diagnoses, medications, functional status, cognitive ability, frailty status, and applied STOPPFrail criteria as appropriate.
Results
We reviewed 464 applications; 38 were excluded due to incomplete information and 274 patients (64.3%) met STOPPFrail eligibility criteria (median age 83 years (IQR 77.25–88); 233 (54.7%) female). Those STOPPFrail eligible were prescribed 2194 medications (mean 8, (SD 4)), of which 828 (37.7%) were PIMs. At least one PIM was identified in 250 eligible patients (91.2%). The median number of PIMs was 3 (IQR 2–4), the most common being (i) medications without clear indication identified in 47.0% (
n
 = 129) of patients, (ii) long-term high-dose proton pump inhibitors in 31.4% (
n
 = 86), and (iii) statins in 29.6% (
n
 = 81). For every additional medication prescribed, the odds of identifying a PIM increased by 58% (odds ratio 1.58, 95% CI 1.32–1.89,
p
 < 0.001).
Conclusion
Almost 65% of patients awaiting long-term care are eligible for the application of STOPPFrail criteria with over 90% prescribed at least one PIM. Transition to nursing home care represents an opportunity to review therapeutic appropriateness and goals of prescribed medications.