Table 2:
Examples of tools to assist with medication review and deprescribing35
| Tool | Description | Level of evidence | Comments |
|---|---|---|---|
| Beers criteria32 | List of drugs of concern in geriatric care and associated quality of evidence and strength of recommendation | Consensus of expert panel using Delphi technique; strong link between medications on the list and poor patient outcomes confirmed in studies | Many of the drugs are older and out of use; excludes drugs of concern with insufficient evidence |
| STOPP34 | Screening tool with 65 indicators; focuses on drug–drug and drug–disease interactions | Items groups by physiologic systems and by drug class; short time to complete | |
| START36 | Screening tool to identify possible prescribing omissions | Similar to STOPP in structure; it does not relate to deprescribing but may help optimize medications | |
| Anticholinergic risk scale (ARS)37 | Ranked categorical list of commonly prescribed medications with anticholinergic potential | Statistically significant correlation between higher ARS scores and increased risk of anticholinergic adverse effects | May help identify medications contributing to adverse effects such as confusion, urinary retention |
| ARMOR38 | Algorithm that prompts review of drug classes, interactions, functional status, systems review and reassess status | Tested in only 1 nursing facility | Can be used to assess medications, initial assessment, falls or behavioural disturbance, and rehabilitation potential |
| Geriatric–palliative method39 | Consensus-based flowchart to reduce polypharmacy | Applied in 6 geriatric nursing departments, (119 patients); significant reduction in mortality, hospital admissions and cost | |
| Prescribing Optimization Method40 | 6 questions to guide general practitioners to address under-treatment, adherence, inappropriate drugs, adverse drug reactions, interactions and dosing | Improvement in optimal prescribing by 45 physicians when applied to a patient case history | |
| Choosing Wisely Canada (www.choosingwiselycanada.org/recommendations/canadian-geriatrics-society-2/) and Choosing Wisely (www.choosingwisely.org/doctor-patient-lists/american-geriatrics-society/) | Management recommendations from the American and Canadian Geriatrics Societies | Expert opinion based on variety of evidence levels | Recommendations may advise against use of specific medications in older patients or advise on treatment targets that could facilitate deprescribing (e.g., hemoglobin A1C target and oral agents) |
Note: ARMOR = assess, review, minimize, optimize, reassess; START = screening tool to alert doctors to the right treatment; STOPP = screening tool of older persons’ potentially inappropriate prescriptions.