Deprescribing in cognitively vulnerable older people: development and validation of STOPPCog criteria

Objective To validate STOPPCog, a list of explicit criteria for potentially inappropriate medication use in cognitively vulnerable older adults. Design A Delphi consensus survey of an expert panel comprising academic geriatricians, old age psychiatrists, general practitioners, and clinical pharmacists. Setting Ireland. Subjects Nine panellists. Methods STOPPCog criteria were initially created by the authors based on clinical experience and literature appraisal. Criteria were organised according to drug/drug class. Using Delphi consensus methodology, panellists ranked their agreement with each criterion on a 5-point Likert scale and provided written feedback. Criteria with a median value of 1 or 2 (strongly agree/agree) and a 25th centile value of ≤2 were included in the final list. Results All panellists completed two Delphi consensus validation rounds. Twenty-five criteria were proposed initially, twenty were accepted. One criterion was rejected (multi-vitamin supplements), and four criteria were rephrased (two of these were combined to one criterion for greater clarity). The final list comprised 23 criteria that are arranged in six subgroups i.e. (i) drugs with anticholinergic properties taken daily; (ii) drugs with sedative properties taken daily; (iii) drugs that may exacerbate psychotic symptoms in patients with alpha-synuclein pathology; (iv) drugs used for chronic pain; (v) drugs without proven efficacy for dementia taken daily; (vi) drugs that are of no proven benefit in advanced stage dementia i.e. clinical dementia rating of 3.0 where palliation may be appropriate. Conclusion STOPPCog comprises 23 criteria relating to medications that are potentially inappropriate in cognitively vulnerable older adults. STOPPCog may assist physicians in deprescribing medications in this patient population.