Today we have Dr. Nathalie van der Velde, Professor in Geriatrics at Amsterdam University Medical Centers (the Netherlands), telling about the development of STOPPFalls, part of the STOPP/START series, and the implications of this new tool. Take it away, Nathalie!
Deprescribing is an essential component of falls prevention
Falls are the leading cause of injury and injury-related death among older adults and are among the biggest contributors to health care spending among community-dwelling older people.
Though falls might be contributed to by several factors, the use of fall-risk-increasing drugs (FRIDs) is one of the most prominent risk factors. Therefore, a medication review – aimed at deprescribing FRIDs – is considered an essential component of the multifactorial falls intervention.
Although FRIDs use is common in older persons, health care professionals are often reluctant to deprescribe FRIDs. In addition, health care professionals, as well as older people and their caregivers, may not be aware of the role of medications as a fall risk factor. The European Geriatric Medicine Society (EuGMS) Task & Finish Group on FRIDs (EuGMS T&F Group on FRIDs) have taken it upon themselves to promote appropriate deprescribing in older persons at risk of falls through raising public awareness, knowledge dissemination activities, knowledge updates, and development of personalized and effective deprescribing interventions, all aimed at optimizing and harmonizing practices among Europe.
Development of STOPPFalls
The latest accomplishment of our group, in collaboration with the EuGMS Special Interest Group on Pharmacology, is the development of the STOPPFalls deprescribing instrument. This European consensus FRIDs deprescribing tool has recently been published in Age & Ageing. The tool provides practical guidance to simplify and structure FRIDs deprescribing in clinical practice and it has been translated to a freely available online digital deprescribing decision tool.
STOPPFalls accompanying online deprescribing decision tool
STOPPFalls was built through a Delphi process of European experts and resulted in a list of 14 FRIDs. These are mostly psychotropic medications, anticholinergics, and cardiovascular drugs. Also, 18 differences between pharmacological subclasses were identified with regard to fall-risk-increasing properties and practical deprescribing guidance to assist with clinical decision making. This information was summarized in overview tables and made easily interpretable by providing decision trees per medication group.
Remarkably, the STOPPFalls list is more comprehensive than most national falls prevention guideline listings!
What is included in STOPPFalls?
STOPPFalls is formally part of the STOPP/START series and the results will be included in the draft criteria for the anticipated STOPP/START version 3, to be further validated by the STOPP/START panelists. The STOPPFalls goes beyond STOPPFrail in a few ways. Firstly, it takes the next step by providing decision trees per drug group that aid users in all essential steps of deprescribing. It also supports decision-making by listing guidelines and evidence-based advice. For example, for all drug groups, the tool lists which symptoms should prompt deprescribing and also which symptoms need to be monitored after deprescribing. The tool also includes advice on tapering. All advice is backed up with links to literature references. Secondly, whereas the STOPPFrail advice is solely aimed at frail older persons, STOPPFalls includes advice for both frail and fit older people and everyone in between.
Next steps with STOPPFalls
One of the next steps for our group will be to obtain funding to validate the tool and assess its effectiveness on falls prevention, preferably in a European, multicenter, and multi-country randomized controlled study. But in between, we are performing a systematic review and meta-analysis to summarize evidence on the effectiveness of different deprescribing tools (including general ones) on fall risk and related injury. This paper is anticipated to be published in the second half of 2021 and will inform the recommendations of the ongoing world falls guideline effort.
(Photo: Dirk Gillissen)
If you have questions for Nathalie, you can reach her via e-mail: n.vandervelde@amsterdamumc.nl
The deprescribing blog is hosted by pharmacists and postdoctoral researchers, Carina Lundby and Wade Thompson. We hope to be your new best deprescribing friends and supply you with deprescribing content and analysis on a monthly basis. Please reach out to us if you have any questions or comments, or would like to contribute.
carina.lundby.olesen@rsyd.dk (Twitter: @CarinaLundby)
wthompson@health.sdu.dk (Twitter: @wadddee)
