Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Department of Internal Medicine and Paediatrics (section of Geriatrics), Ghent University, Ghent, Belgium.
Age Ageing. 2021 Jun 28;50(4):1189-1199. doi: 10.1093/ageing/afaa249.
Healthcare professionals are often reluctant to deprescribe fall-risk-increasing drugs (FRIDs). Lack of knowledge and skills form a significant barrier and furthermore, there is no consensus on which medications are considered as FRIDs despite several systematic reviews. To support clinicians in the management of FRIDs and to facilitate the deprescribing process, STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk) and a deprescribing tool were developed by a European expert group.
STOPPFall was created by two facilitators based on evidence from recent meta-analyses and national fall prevention guidelines in Europe. Twenty-four panellists chose their level of agreement on a Likert scale with the items in the STOPPFall in three Delphi panel rounds. A threshold of 70% was selected for consensus a priori. The panellists were asked whether some agents are more fall-risk-increasing than others within the same pharmacological class. In an additional questionnaire, panellists were asked in which cases deprescribing of FRIDs should be considered and how it should be performed.
The panellists agreed on 14 medication classes to be included in the STOPPFall. They were mostly psychotropic medications. The panellists indicated 18 differences between pharmacological subclasses with regard to fall-risk-increasing properties. Practical deprescribing guidance was developed for STOPPFall medication classes.
STOPPFall was created using an expert Delphi consensus process and combined with a practical deprescribing tool designed to optimise medication review. The effectiveness of these tools in falls prevention should be further evaluated in intervention studies.
医疗保健专业人员通常不愿意减少增加跌倒风险的药物（FRIDs）。缺乏知识和技能是一个重大障碍，此外，尽管有几项系统评价，但对于哪些药物被认为是 FRIDs 尚未达成共识。为了支持临床医生管理 FRIDs 并促进减少用药过程，一个欧洲专家组开发了 STOPPFall（老年人高跌倒风险的处方筛选工具）和一个减少用药工具。
STOPPFall 由两位协调员根据最近的荟萃分析和欧洲国家预防跌倒指南中的证据创建。24 名小组成员在三轮 Delphi 小组中对 STOPPFall 中的项目进行了李克特量表的同意程度评估。事先选择了 70%的阈值作为共识标准。小组成员被问到在同一药物类别中，某些药物是否比其他药物更增加跌倒风险。在额外的问卷中，小组成员被问到在哪些情况下应考虑减少 FRIDs 的使用以及应如何进行。
小组成员同意将 14 种药物类别纳入 STOPPFall。它们大多是精神药物。小组成员指出，在增加跌倒风险的特性方面，药理学亚类之间存在 18 种差异。为 STOPPFall 药物类别制定了实用的减少用药指导。
STOPPFall 使用专家 Delphi 共识过程创建，并结合了旨在优化药物审查的实用减少用药工具。这些工具在预防跌倒方面的有效性应在干预研究中进一步评估。
