Table 2.
STOPP Version 3 criteria applied to TILDA data for study participants aged ≥ 65 years (N = 3619)
| STOPP criteria description | PIM (n) | PIM (%) | Prescribing per indication (%)a |
|---|---|---|---|
| Indication of medication | |||
| Any drug prescribed beyond the recommended duration | |||
| Z-drugs | 93 | 2.57 | 59.62 |
| NSAIDs | 100 | 2.76 | 68.03 |
| Any duplicate drug class prescription | 125 | 3.45 | 4.73 |
| Duplicate NSAIDs | 11 | 0.3 | 4.82 |
| Duplicate SSRIs | 7 | 0.19 | 3.52 |
| Duplicate loop diuretics | 4 | 0.11 | 2 |
| Duplicate ACEIs | 12 | 0.33 | 1.88 |
| Duplicate anticoagulants | 6 | 0.17 | 1.81 |
| Duplicate antipsychotics | 6 | 0.17 | 8.45 |
| Duplicate opioids | 11 | 0.3 | 6.04 |
| Duplicate stimulant laxatives | 0 | – | – |
| Duplicate thiazides | 0 | – | – |
| Duplicate beta blockers | 16 | 0.44 | 1.94 |
| Duplicate ARBs | 14 | 0.39 | 2.01 |
| Duplicate CCBs | 9 | 0.25 | 1.44 |
| Duplicate statins | 25 | 0.69 | 1.59 |
| Duplicate benzodiazepines | 8 | 0.22 | 5.63 |
| Duplicate TCAs | 0 | – | – |
| Cardiovascular system | |||
| Beta-blocker in combination with verapamil or diltiazem | 11 | 0.3 | 17.19 |
| Beta-blocker as monotherapy for uncomplicated hypertension | 42 | 1.16 | 4.12 |
| Loop diuretic as first-line treatment for hypertension unless there is concurrent heart failure | 24 | 0.66 | 1.64 |
| Thiazide diuretic with a history of gout (defined as prior use of anti-gout medication) | 4 | 0.11 | 2.53 |
| Loop diuretic for treatment of hypertension with concurrent urinary incontinence | 21 | 0.58 | 6.46 |
| Centrally acting antihypertensives | 0 | – | – |
| Phosphodiesterase type-5 inhibitors with concurrent nitrate therapy for angina | 1 | 0.03 | 1.3 |
| Statins for primary cardiovascular prevention in persons aged ≥ 85 and established frailty | 10 | 0.28 | 45.45 |
| Long-term systemic i.e. non-topical NSAIDs with known history of coronary, cerebral or peripheral vascular disease | 14 | 0.39 | 1.43 |
| Long-term antipsychotics with known history of coronary, cerebral or peripheral vascular disease | 11 | 0.30 | 1.12 |
| NSAIDs or systemic corticosteroids with heart failure requiring loop diuretic therapy | 1 | 0.03 | 7.69 |
| Coagulation system | |||
| Ticlopidine in any circumstances | 0 | – | – |
| Antiplatelet agents as alternatives to vitamin K antagonists, direct thrombin inhibitors or factor Xa inhibitors for stroke prevention in patients with chronic atrial fibrillation | 30 | 0.83 | 19.48 |
| NSAIDs and vitamin K antagonist, direct thrombin inhibitor or factor Xa inhibitors in combination | 6 | 0.17 | 2.48 |
| Direct thrombin inhibitor (e.g. dabigatran) and diltiazem or verapamil | 7 | 0.19 | 10.94 |
| Apixaban, dabigatran, edoxaban, rivaroxaban and P-glycoprotein (P-gp) drug efflux pump inhibitors | 15 | 0.41 | 11.72 |
| Aspirin for primary prevention in cardiovascular disease | 535 | 14.78 | 21.80 |
| Central nervous system | |||
| Tricyclic antidepressants (TCAs) in patients with dementia, glaucoma or recent falls | 35 | 0.97 | 3.49 |
| Benzodiazepines for ≥ 4 weeks | 64 | 1.77 | 55.65 |
| Benzodiazepines for agitated behaviour or psychotic symptoms of dementia | 0 | – | – |
| Benzodiazepines for insomnia for ≥ 2 weeks | 27 | 0.75 | 23.48 |
| Z-drugs (zolpidem, zopiclone, zaleplon) for insomnia for ≥ 2 weeks | 39 | 1.08 | 25.00 |
| Antipsychotics (i.e. other than clozapine or quetiapine) in those with parkinsonism | 1 | 0.03 | 2.5 |
| Anticholinergic/antimuscarinic drugs to treat extra-pyramidal side-effects of antipsychotic medications | 0 | – | – |
| Drugs with potent anticholinergics/antimuscarinic effects in patients with dementia | 7 | 0.19 | 8.14 |
| Antipsychotics as hypnotics, unless sleep disorder is due to psychosis or BPSD effects of dementia | 10 | 0.28 | 8.4 |
| Acetylcholinesterase inhibitors with concurrent treatment with drugs that induce persistent bradycardia such as beta-blockers, digoxin, diltiazem, verapamil | 15 | 0.41 | 1.68 |
| Memantine with known current or previous seizure disorder | 0 | – | – |
| Nootropics in dementia | 0 | – | – |
| Levodopa or dopamine agonists for treatment of extra-pyramidal side-effects of antipsychotics (inappropriate prescribing cascade) | 0 | – | – |
| Gastrointestinal system | |||
| Prochlorperazine or metoclopramide with Parkinsonism | 0 | – | – |
| Corticosteroids with a history of peptic ulcer disease | 2 | 0.06 | 0.62 |
| Respiratory system | |||
| Theophylline as monotherapy for COPD | 0 | – | – |
| Systemic corticosteroids instead of inhaled corticosteroids for maintenance therapy in moderate-severe COPD | 5 | 0.14 | 9.43 |
| Long-acting muscarinic antagonists with a history of glaucoma | 4 | 0.11 | 3.05 |
| Musculoskeletal system | |||
| Non-steroidal anti-inflammatory drugs (NSAIDs) other than COX-2 selective agents with history of peptic ulcer disease or gastrointestinal bleeding, unless with concurrent PPI or H2 antagonist | 14 | 0.39 | 4.32 |
| Long-term corticosteroids (> 3 months) as monotherapy for rheumatoid arthritis | 4 | 0.11 | 1.30 |
| Corticosteroids (other than periodic intra-articular injections for mono-articular pain) for osteoarthritis | 20 | 0.55 | 2.77 |
| NSAID with concurrent corticosteroids for treatment of arthritis/rheumatism of any kind | 3 | 0.08 | 0.22 |
| Oral bisphosphonates in patients with a current or recent history of upper gastrointestinal | 18 | 0.5 | 5.56 |
| Long-term opioids for osteoarthritis | 32 | 0.88 | 6.13 |
| Urogenital system | |||
| Systemic antimuscarinic drugs with dementia or chronic cognitive impairment | 8 | 0.22 | 9.3 |
| Systemic antimuscarinic drugs with glaucoma | 11 | 0.30 | 8.4 |
| Endocrine system | |||
| Sulphonylureas with a long half-life with type 2 diabetes mellitus | 0 | – | – |
| Thiazolidenediones with heart failure | 0 | – | – |
| Systemic oestrogens with a history of breast cancer | 1 | 0.03 | 0.89 |
| Vasopressin analogues for urinary incontinence or urinary frequency | 1 | 0.03 | 0.14 |
| Drug classes that predictably increase falls risk | |||
| Benzodiazepines in patients with recurrent falls | 18 | 0.50 | 4.83 |
| Antipsychotic drugs in patients with recurrent falls | 10 | 0.28 | 2.68 |
| Hypnotic Z-drugs in patients with recurrent falls | 30 | 0.83 | 8.04 |
| Anti-epileptic drugs in patients with recurrent falls | 47 | 1.30 | 12.60 |
| First generation antihistamines in patients with recurrent falls | 2 | 0.06 | 0.54 |
| Opioids in patients with recurrent falls | 39 | 1.08 | 10.46 |
| Antidepressants in patients with recurrent falls | 97 | 2.68 | 26.01 |
| Centrally acting antihypertensives | 0 | – | – |
| Antimuscarinics for treatment of overactive bladder or urge incontinence | 44 | 1.22 | 6.33 |
| Analgesic drugs | |||
| Topical lidocaine patch for treatment of chronic osteoarthritis pain | 13 | 0.36 | 1.54 |
| Antimuscarinic/anticholinergic drug burden | |||
| Concomitant use of two or more drugs with antimuscarinic/anticholinergic properties | 19 | 0.53 | 8.15 |
| Any STOPP indicator | 1123 | 31.03 | |
| 1 indicator | 814 | 22.49 | – |
| ≥ 2 indicators | 309 | 8.54 | – |
a Calculated as the proportion of overall disease or medication prevalence (e.g. use of medication with potent anticholinergic/antimuscarinic effects in participants with dementia as a proportion of dementia prevalence). Further detail on the disease/medication denominator used for each criterion is provided in Additional File 2