Clinical relevance of the STOPP/START criteria in hip fracture patients

Lönnbro, Johan; Wallerstedt, Sven

doi:10.1007/s00228-016-2188-9

Cited by 32 publications

(37 citation statements)

References 33 publications

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“…Furthermore, the joint expertise of the clinical pharmacologist and the geriatrician in the evaluation of the individual patient records strengthens the evaluations and conclusions in our report. The female preponderance, age, high frequency of comorbidities, widespread use of medications, FRIDs, and PIMs in our patients correspond well to those from other studies of Danish and international cohorts of patients with hip fractures [11,12,[24][25][26]. Thus, our population may be a representative sample of elderly patients with hip fracture.…”

Section: (37)supporting

confidence: 84%

“…Thus, FRIDs can be regarded as a modifiable risk factor. Furthermore, a recent study showed that 85% of elderly patients with a hip fracture were prescribed potentially inappropriate medications (PIMs), which may be unnecessary or entail a high risk of adverse effects [12]. The Screening Tool of Older Persons' Prescriptions (STOPP) [13] may guide the performance of a medication review, both by pointing out situations in which certain medications are potentially inappropriate and by identifying certain FRIDs as PIMs.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of medication-related falls in 200 consecutive elderly patients with hip fractures: a cross-sectional study

et al. 2020

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Background: Hip fractures constitute a major health problem in elderly people and are often fall-related. Several factors can contribute to a fall episode leading to hip fracture, including fall-risk-increasing drugs (FRIDs), which are often used by elderly people. We aimed to investigate the prevalence of medication-related falls and to assess the role of FRIDs and potentially inappropriate medications (PIMs) in a population of elderly patients hospitalized for a hip fracture. Methods: We reviewed the patient records of 200 consecutive patients, aged ≥65 years, who were admitted for a hip fracture and evaluated whether medications were likely to have contributed to the fall episode. PIMs were identified using the Screening Tool of Older Persons' Prescriptions version 2 (STOPP) and by evaluating indications, contra-indications and interactions of the prescribed medications for each patient. Results: FRIDs were used by 175 patients (87.5%). Medications were considered a likely contributor to the fall in 82 patients (41%). These were most often psychotropic medications alone or in combination with antihypertensives and/or diuretics. The 82 patients with suspected medication-related falls used more medications, FRIDs and PIMs than the rest of the patients, and in 74 (90%) of the 82 patients, at least one medication considered to be a contributor to the fall was also a PIM. Conclusions: The prevalence of suspected medication-related falls was 41%. It seems likely that a medication review could have reduced, though not eliminated, the risk of falling in this group of patients.

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Section: (37)supporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Prevalence of medication-related falls in 200 consecutive elderly patients with hip fractures: a cross-sectional study

et al. 2020

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“…Summarized, drawing conclusions on prescribing quality from our results may be a delicate task, as register data lack important information for individualized treatment decisions. Indeed, indicators of prescribing quality often have limited applicability at the individual patient level [29,30]. Nevertheless, one cannot exclude that undertreatment may exist to some extent, as has previously been suggested [31].…”

Section: Discussionmentioning

confidence: 99%

Use of statins in the elderly according to age and indication—a cross-sectional population-based register study

Sundvall

Fastbom

Wallerstedt

et al. 2019

Eur J Clin Pharmacol

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Purpose To investigate statin use in the elderly by age (≥ 80 vs. 65-79 years) in relation to established indications. Methods A population-based cohort, including data from four registers, encompassing inhabitants in Region Västra Götaland, Sweden, was used. Statin users were defined as those filling statin prescriptions ≥ 75% of the year 2010. Primary care and hospital diagnoses in 2005-2010 regarding ischemic heart disease, stroke, transient ischemic attacks, and diabetes were considered established indications. Results A total of 278,205 individuals were analyzed. In individuals aged ≥ 80 and 65-79 years (n = 81,885 and n = 196,320, respectively), 17% (95% confidence interval 17%; 18%) and 23% (23%; 23%) respectively, were statin users. Among the statin users, 74% (73%; 74%) of those aged ≥ 80 and 60% (59%; 60%) of those aged 65-79 years had ≥ 1 established indication. Conversely, of those with ≥ 1 established indication, 30% (30%; 31%) and 53% (52%; 53%) were on statins in the respective age groups. Logistic regression revealed that age, nursing home residence, and multi-dose drug dispensing were the most prominent negative predictors for statin use; adjusted odds ratios (95% confidence interval): 0.45 (0.44; 0.46), 0.39 (0.36; 0.42), and 0.47 (0.44; 0.49), respectively. Conclusions In the oldest old (≥ 80 years), statin users were fewer and had more often an established indication, suggesting that physicians extrapolate scientific evidence for beneficial effects in younger age groups to the oldest, but require a more solid ground for treatment. As the oldest old, nursing home residents, and those with multi-dose drug-dispensing were statin users to a lesser extent, physicians may often refrain from treatment in those with lower life expectancy, either due to age or to severely reduced health status. In both age groups, our results however also indicate some over-as well as undertreatment.

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“…8 Secondly, baseline functionality, based on the Barthel index (total, severe, moderate, slight or no dependence), 15 ambulation (independence/1 stick; walker/2 sticks; high assistance; not walk), 16 Thirdly, surgical features such as surgical intervention, surgical urgency, surgery type (nail, partial bipolar prosthesis, monopolar prosthesis, total prosthesis and screws), 8 ASA scores (II -Moderate Systemic Disease; III -Severe Non-disabling Systemic Disease; IV -Severe Vital-risk Systemic Disease), 18 and non-surgical cause (death, orthopedic care, high surgical risk and hospital transfer), 5 as well as baseline pharmacologic treatments (anti-hypertensives, benzodiazepines, antidepressants, proton-pump inhibitors, antiplatelets, anticoagulants, oral antidiabetic agents, analgesics, antidementia, neuroleptics, anti-osteoporosis, bronchodilators, domiciliary Oxygen, anti-Parkinsonians and Insulin) were determined. 19 Finally, complications (anemia, transfusion, delirium, constipation, renal function alteration, urinary tract infection, infection or respiratory insufficiency, malnutrition, heart failure, acute retention of urine, ischemic heart disease, death, pressure ulcers, seroma, surgical wound infection, ictus, venous thrombosis or thromboembolism), 20 and features at hospital discharge (destination, home move, ambulation and discharge) were observed. 21…”

Section: Procedures Ant Outcomesmentioning

confidence: 99%

Functionality, comorbidity, complication & surgery of hip fracture in older adults by age distribution

Jiménez-Mola

Calvo‐Lobo

Idoate-Gil

et al. 2018

Rev. Assoc. Med. Bras.

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SUMMARY BACKGROUND Hip fractures may be the greatest complication secondary to osteoporotic disorder. The objective of this study was to determine the influence of age distribution in the functionality, comorbidity, complications and surgical features of older adults with hip fractures. METHODS A prospective cohort study was carried out from 2013 to 2014. A sample of 557 adults over 75 years old with osteoporotic hip fractures was recruited from the Orthogeriatric Unit of the León University Hospital (Spain). Age distributions of 75–84, 85–90 and >90 years old were considered. Firstly, sociodemographic data, fracture type and hospital staying days were collected. Secondly, baseline functionality (Barthel index), ambulation, cognitive impairment and comorbidities were described. Thirdly, surgical intervention, urgency, type, American Association of Anesthesiologists (ASA) scores, non-surgical cause, and baseline pharmacologic treatments were determined. Finally, complications and features at hospital discharge were observed. RESULTS The age ranges did not show any statistically-significant differences (P<.05; R2=.000–.005) for gender, fracture type, or number of hospital staying days. Statistically-significant differences (P<.05; R2=.011–.247) between age groups were observed for Barthel index, cognitive impairment, dementia, osteoporosis, Parkinson’s disease, aortic stenosis, surgery type, ASA–score, non-surgical cause, benzodiazepines, antidementia, anti-osteoporosis, insulin, pharmacologic treatments, renal function alteration, heart failure, destination and ambulation features. All other measurements did not show statistically-significant differences (P>.05; R2=.000–.010). CONCLUSION Age distributions greater than 75 years old may determine the functionality, comorbidities, surgical features, baseline pharmacologic treatments, complications and features at hospital discharge for older adults who suffer a hip fracture.

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Clinical relevance of the STOPP/START criteria in hip fracture patients

Cited by 32 publications

References 33 publications

Prevalence of medication-related falls in 200 consecutive elderly patients with hip fractures: a cross-sectional study

Prevalence of medication-related falls in 200 consecutive elderly patients with hip fractures: a cross-sectional study

Use of statins in the elderly according to age and indication—a cross-sectional population-based register study

Functionality, comorbidity, complication & surgery of hip fracture in older adults by age distribution

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