Background: Older people with multimorbidity often experience polypharmacy. Taking multiple medicines can be beneficial; however, some older adults are prescribed multiple medicines when they are unlikely to improve clinical outcomes and may lead to harm. Deprescribing means reducing or stopping prescription medicines which may no longer be providing benefit. While appropriate deprescribing may usually be safely undertaken, there is a lack of guidance about how to implement it in practice settings such as care homes. Implementing deprescribing in care homes is often challenging, due to differing concerns of residents, staff, clinicians, friends/family members and carers along with differences in care home structures. The STOPPING study will support the development of better deprescribing practice in care homes, considering different views and environments. This paper aims to introduce the research protocol. Methods: We will use qualitative approaches informed by the widely accepted Consolidated Framework for Implementation Research (CFIR) to aid analysis. To understand the barriers, facilitators, and contextual factors influencing deprescribing in care homes, we will employ individual interviews with care home residents and family members, focus groups with care home staff and healthcare professionals, and observations from care homes. Then, we will examine acceptability, feasibility, and suitability of existing deprescribing approaches using cognitive interviews with care home staff and healthcare professionals. Lastly, we will use narrative synthesis to integrate findings and develop guidance for implementing a deprescribing approach for care homes. Discussion: This research will support the development of implementable approaches to deprescribing in care homes. The insights from this project will be shared with various stakeholders: care home residents, staff, pharmacists, general practitioners, nurses, and other health professionals, carers, researchers, and the public. This work will support deprescribing to be implemented effectively in care homes to benefit residents and the wider health economy.

IntroductionObesity is a risk factor for the development of colorectal cancer (CRC).1 Colonoscopy in obese patients has been suggested to be more technically difficult,2 3 but variation in indication and age of patients, and operator technical ability may be confounding factors. The Bowel Cancer Screening Programme (BCSP) has a single indication for colonoscopy in a narrow age band (60–70 years) and the colonoscopists are of a proven standard, therefore studying data from this group of patients may avoid confounding factors and give a truer assessment of technical difficulty.MethodsWe compared measures of technical difficulty (quality of preparation; caecal intubation rate and time; sedation/analgesia dose; and patient tolerance) and findings (polyp and cancer detection) in the Taunton Faecal Occult Blood positive (FOB+ve) BCSP colonoscopy patients in 2008/9 (N=359, males 209, females 150) in relation to their BMI.ResultsBMI was known in 348, and was 15.7–58.3 (median 28.0). One hundred and eleven patients (31.8%) had BMI >30. Bowel preparation scores were not affected by BMI (Fisher's Exact Test, p=0.62), nor were sedation and analgesia requirements (all comparisons obese vs non-obese, Fisher's Exact Test or regression analysis). Comfort scores were similar (minimal or no discomfort 63% vs 68%, p=0.33). Overall caecal intubation rates were 96.3%, vs 97.4% (p=0.73). Caecal intubation time was not effected by BMI (r=0.022, p=0.68). Polyps were found in 210 (58.4%) patients and cancer in 43 (11.9%) in total. BMI did not affect the number of polyps found (p=0.33). There was no significant difference in the number of cancers identified in patients with a BMI>30 (14 of 97) compared to the others (29 of 208) (p=1.0).ConclusionObesity does not impair the technical performance of colonoscopy in this population. There is a high rate of obesity in the FOB +ve BCSP population, but the effect of obesity on findings cannot be assessed by this study, since the proportion of obese patients in the overall population from which this group is drawn was not available. Nether-the-less this study suggests that obesity should not be a factor in deciding whether colonoscopy is an appropriate investigation to exclude CRC.

Background: Older people with multimorbidity often experience polypharmacy. Taking multiple medicines can be beneficial; however, some older adults are prescribed multiple medicines when they are unlikely to improve clinical outcomes and may lead to harm. Deprescribing means reducing or stopping prescription medicines which may no longer be providing benefit. While appropriate deprescribing may usually be safely undertaken, there is a lack of guidance about how to implement it in practice settings such as care homes. Implementing deprescribing in care homes is often challenging, due to differing concerns of residents, staff, clinicians, friends/family members and carers along with differences in care home structures. The STOPPING study will support the development of better deprescribing practice in care homes, considering different views and environments. This paper aims to introduce the research protocol. Methods: We will use qualitative approaches informed by the widely accepted Consolidated Framework for Implementation Research (CFIR) to aid analysis. To understand the barriers, facilitators and contextual factors influencing deprescribing in care homes, we will employ individual interviews with care home residents and family members, focus groups with care home staff and healthcare professionals, and observations from care homes. Then, we will examine acceptability, feasibility, and suitability of existing deprescribing approaches using cognitive interviews with care home staff and healthcare professionals. Lastly, we will use narrative synthesis to integrate findings and develop guidance for implementing a deprescribing approach for care homes.Discussion: This research will support the development of implementable approaches to deprescribing in care homes. The insights from this project will be shared with various stakeholders: care home residents, staff, pharmacists, general practitioners, nurses, and other health professionals, carers, researchers, and the public. This work will support deprescribing to be implemented effectively in care homes to benefit residents and the wider health economy.