Amanda Lavan2, Paul Gallagher1, Carole Parsons3, Denis O’Mahony1
1Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
2Department of Medicine, University College Cork, Cork, Ireland
3School of Pharmacy, Queen’s University Belfast, Belfast, Ireland
Background: To validate STOPPFrail, a list of explicit criteria for potentially inappropriate
medications (PIMs) in frailer older adults with limited life expectancy. A Delphi consensus
survey of an expert panel (n = 17) comprising specialists in geriatric medicine, clinical
pharmacology, palliative care, psychiatry of old age, clinical pharmacy and general practice.
Methods: STOPPFrail criteria was initially created by the authors based on clinical
experience and appraisal of the available literature. Criteria were organised according to
physiological system. Each criterion was accompanied by an explanation. Panellists
ranked their agreement with each criterion on a 5-point Likert scale and invited to provide
written feedback. Criteria with a median Likert response of 4/5 (agree/strongly
agree) and a 25th centile of ≥4 were included in the final criteria.
Results: Three Delphi rounds were required. All panellists completed all rounds. Thirty
criteria were proposed for inclusion; 26 were accepted. No new criteria were added. The
first two criteria suggest deprescribing medications with no indication or where compliance
is poor. The remaining 24 criteria include lipid-lowering therapies, alpha-blockers for
hypertension, anti-platelets, neuroleptics, proton pump inhibitors, H-2 receptor antagonists,
anti-spasmodics, theophylline, leukotriene antagonists, calcium supplements, bone
anti-resorptive therapy, selective oestrogen receptor modulators, non-steroidal antiinflammatories,
corticosteroids, 5-alpha reductase inhibitors, alpha-1 selective blockers,
muscarinic antagonists, oral diabetic agents, ACE-inhibitors, angiotensin receptor blockers,
systemic oestrogens, multivitamins, nutritional supplements and prophylactic antibiotics.
Anticoagulants and anti-depressants were excluded. Despite incorporation of
panellists’ suggestions, memantine and acetyl-cholinesterase inhibitors remained
Conclusion: STOPPFrail comprises 26 criteria, which have been judged by broad consensus,
to be potentially inappropriate in frailer older patients with limited life expectancy.
STOPPFrail may assist in deprescribing medications in these patients.