BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Agaplesion Bethesda Clinic Geriatric Research Unit Ulm University and Geriatric Centre Ulm Ulm Germany

Department of Clinical Gerontology King's College London England UK

Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons University Medical Center Utrecht Utrecht University Utrecht The Netherlands

Department of Geriatric Medicine Cork University Hospital Cork Ireland and Department of Medicine University College Cork Cork Ireland

Department of Geriatric Medicine Odense University Hospital Odense Denmark and Geriatric Research Unit Department of Clinical Research University of Southern Denmark Odense Denmark

Department of Geriatrics and Gerontology 1st Faculty of Medicine Charles University Prague Czech Republic and Faculty of Health and Social Sciences South Bohemian University Česke Budějovice Czech Republic

Department of Geriatrics University Medical Center Utrecht Utrecht University Utrecht The Netherlands

Department of Gerontology Neuroscience and Orthopedics Catholic University of the Sacred Heart Rome Italy

Department of Internal Medicine and Paediatrics Ghent University Ghent Belgium

Department of Internal Medicine Erasmus MC University Medical Centre Rotterdam Rotterdam The Netherlands and Department of Epidemiology Erasmus MC University Medical Centre Rotterdam Rotterdam The Netherlands

Department of Internal Medicine Section of Geriatric Medicine Amsterdam Public Health Research Institute Amsterdam UMC University of Amsterdam Amsterdam The Netherlands

Division of Geriatrics Department of Internal Medicine Şişli Hamidiye Etfal Training and Research Hospital University of Medical Sciences Istanbul Turkey

Effective Prescribing and Therapeutics Health and Social Care Directorate Scottish Government Edinburgh Scotland UK

Faculty of Industrial Design Engineering Delft University of Technology Delft The Netherlands

Geriatria Accettazione Geriatrica e Centro di ricerca per l'invecchiamento IRCCS INRCA Ancona Italy

Health Care of Older People East Kent Hospitals University NHS Foundation Trust Canterbury Kent UK

Institute for Clinical Pharmacology Medical Faculty Mannheim Ruprecht Karls University Heidelberg Germany

Istanbul Medical School Department of Internal Medicine Division of Geriatrics Istanbul University Capa Istanbul Turkey

Laboratory for Research on Aging Society Department of Sociology of Medicine Epidemiology and Preventive Medicine Chair Faculty of Medicine Jagiellonian University Medical College Krakow Poland

Landspitali University Hospital Iceland and Faculty of Medicine University of Iceland Reykjavik Iceland

Outpatient Geriatric Assessment Unit Henry Dunant Hospital Center Athens Greece

Research Department of Primary Care and Population Health University College London London UK

School of Pharmacy University of Eastern Finland Kuopio Finland

Servicio de Geriatría Hospital General Universitario de Ciudad Real and CIBER de Fragilidad y Envejecimiento Saludable Spain

Servicio de Geriatría Hospital Universitario Ramón y Cajal Madrid Spain

Unit of Innovation and Organization Navarre Health Service Pamplona Spain

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Eur Geriatr Med. 2021 Aug;12(4):671-672. doi: 10.1007/s41999-021-00448-w. PubMed

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