Intervention with the Screening Tool of Older Persons Potentially Inappropriate Prescriptions/Screening Tool to Alert Doctors to Right Treatment Criteria in Elderly Residents of a Chronic Geriatric Facility: A Randomized Clinical Trial

Frankenthal, Dvora; Lerman, Yaffa; Kalendaryev, Edward; Lerman, Yehuda

doi:10.1111/jgs.12993

Cited by 169 publications

(290 citation statements)

References 29 publications

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“…Thirteen trials (4226 participants) in care facilities studied multifactorial interventions (Beck 2016; Becker 2003; Dyer 2004; Jensen 2002; Kerse 2004; McMurdo 2000; Neyens 2009; Ray 1997; Rubenstein 1990; Salvà 2016; Shaw 2003; Walker 2015; Whitney 2017). Eleven trials were cluster-randomised trials (Beck 2016; Becker 2003; Dyer 2004; Jensen 2002; Kerse 2004; McMurdo 2000; Neyens 2009; Ray 1997; Salvà 2016; Walker 2015; Whitney 2017; 3470 participants), and two were individually randomised (Rubenstein 1990; Shaw 2003; 756 participants).…”

Section: Resultsmentioning

confidence: 99%

“…Two studies did not report data suitable for use in the quantitative analysis (Beck 2016; Ray 1997). Three studies (2160 participants) reported data on hip fractures (Becker 2003; Jensen 2002; Shaw 2003), and one reported total fractures (Salvà 2016). Three studies (312 participants) reported adverse-event data (Beck 2016; McMurdo 2000; Whitney 2017).…”

Section: Resultsmentioning

confidence: 99%

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Interventions for preventing falls in older people in care facilities and hospitals

Cameron

Dyer²,

Panagoda

et al. 2018

Cochrane Database of Systematic Reviews

355

370

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Background Falls in care facilities and hospitals are common events that cause considerable morbidity and mortality for older people. This is an update of a review first published in 2010 and updated in 2012. Objectives To assess the effects of interventions designed to reduce the incidence of falls in older people in care facilities and hospitals. Search methods We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (August 2017); Cochrane Central Register of Controlled Trials (2017, Issue 8); and MEDLINE, Embase, CINAHL and trial registers to August 2017. Selection criteria Randomised controlled trials of interventions for preventing falls in older people in residential or nursing care facilities, or hospitals. Data collection and analysis One review author screened abstracts; two review authors screened full‐text articles for inclusion. Two review authors independently performed study selection, 'Risk of bias' assessment and data extraction. We calculated rate ratios (RaR) with 95% confidence intervals (CIs) for rate of falls and risk ratios (RRs) and 95% CIs for outcomes such as risk of falling (number of people falling). We pooled results where appropriate. We used GRADE to assess the quality of evidence. Main results Thirty‐five new trials (77,869 participants) were included in this update. Overall, we included 95 trials (138,164 participants), 71 (40,374 participants; mean age 84 years; 75% women) in care facilities and 24 (97,790 participants; mean age 78 years; 52% women) in hospitals. The majority of trials were at high risk of bias in one or more domains, mostly relating to lack of blinding. With few exceptions, the quality of evidence for individual interventions in either setting was generally rated as low or very low. Risk of fracture and adverse events were generally poorly reported and, where reported, the evidence was very low‐quality, which means that we are uncertain of the estimates. Only the falls outcomes for the main comparisons are reported here. Care facilities Seventeen trials compared exercise with control (typically usual care alone). We are uncertain of the effect of exercise on rate of falls (RaR 0.93, 95% CI 0.72 to 1.20; 2002 participants, 10 studies; I² = 76%; very low‐quality evidence). Exercise may make little or no difference to the risk of falling (RR 1.02, 95% CI 0.88 to 1.18; 2090 participants, 10 studies; I² = 23%; low‐quality evidence). There is low‐quality evidence that general medication review (tested in 12 trials) may make little or no difference to the rate of falls (RaR 0.93, 95% CI 0.64 to 1.35; 2409 participants, 6 studies; I² = 93%) or the risk of falling (RR 0.93, 95% CI 0.80 to 1.09; 5139 participants, 6 studies; I² = 48%). There is moderate‐quality evidence that vitamin D supplementation (4512 particip...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Interventions for preventing falls in older people in care facilities and hospitals

Cameron

Dyer²,

Panagoda

et al. 2018

Cochrane Database of Systematic Reviews

355

370

View full text Add to dashboard Cite

show abstract

“…In a recent RCT, the use of the STOPP and START (Screening Tool to Alert doctors to Right Treatment) criteria as intervention guidelines had been shown significantly to reduce the number of medications and falls at a chronic care geriatric facility. In addition, the intervention contributed to a saving of US$29 for every patient monthly [6]. Nevertheless, one particularly important aspect of all available criteria for PIMs is that they only list ''potentially'' inappropriate medications.…”

Section: Main Textmentioning

confidence: 98%

“…Although the exact scope of potentially inappropriate medications (PIMs) may differ between these published criteria, PIMs in older people are generally referred to as medications that lack evidence-based indications, medications with treatment risks that may outweigh their benefits, medications that are significantly associated with ADRs, and those that are likely to interact with other medications or diseases [3]. The literature includes many studies pertaining to the use of PIMs among older people and the use of PIMs has been reported to be prevalent in up to 79 % of older people, depending on the type of criteria used, study settings and countries [4][5][6][7][8].…”

Section: Main Textmentioning

confidence: 98%

The relevance of educating doctors, pharmacists and older patients about potentially inappropriate medications

Wahab

2015

Int J Clin Pharm

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Providing appropriate pharmacotherapy to older people can be difficult since older people are more at risk of developing adverse drug reactions due to age-related physiological changes. The use of potentially inappropriate medications (PIMs) among older people is common throughout the globe, and is a cause for concern due to their clinical, humanistic and economic implications. Nevertheless, it appears that doctors and pharmacists have limited knowledge regarding PIMs. Moreover, uninformed older patients may use PIMs without considering their potential negative consequences. There is a need, therefore, to educate doctors, pharmacists and older patients about PIMs. Geriatric pharmacotherapy education with an emphasis on appropriate prescribing, and PIMs, should be included in the medical and pharmacy teachings at the undergraduate, postgraduate and continuing education levels. Moreover, older patients should be informed about PIMs and the possible risks that they may pose.

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“…Use of the tool enables the identification of avoidable adverse events and improvement in a range of outcomes. [17][18][19] Hence the NICE guideline on medicines optimisation advocates using the STOPP/START tool to identify patients who should be targeted for medication reviews.…”

Section: Identifying Patients Who May Benefit From Deprescribingmentioning

confidence: 99%

Deprescribing: tackling increasing polypharmacy

Krska¹,

Howard²,

Barnett³

2017

Prescriber

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“Deprescribing – is less more?” was the theme of this year's annual scientific meeting organised by the Prescribing and Research in Medicines Management (PRIMM) group, held in London in January. The meeting covered a range of topics relating to deprescribing, including a seven‐step deprescribing model, identifying patients with polypharmacy problems, and providing individualised prescribing.

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Intervention with the Screening Tool of Older Persons Potentially Inappropriate Prescriptions/Screening Tool to Alert Doctors to Right Treatment Criteria in Elderly Residents of a Chronic Geriatric Facility: A Randomized Clinical Trial

Abstract: Implementation of STOPP/START criteria reduced the number of medications, falls, and costs in a geriatric facility. Their incorporation in those and similar settings is recommended.

Cited by 169 publications

References 29 publications

Interventions for preventing falls in older people in care facilities and hospitals

Interventions for preventing falls in older people in care facilities and hospitals

The relevance of educating doctors, pharmacists and older patients about potentially inappropriate medications

Deprescribing: tackling increasing polypharmacy

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