Table 2 .
Deprescribing guidance for STOPPFall items
| Fall-risk assessment: In which cases to consider withdrawal?a |
Is stepwise withdrawal needed?b | Monitoring after deprescribingc | |
|---|---|---|---|
| Always | -If no indication for prescribing-If safer alternative available | -Fall incidence and change in symptoms e.g. OH, blurred vision, dizziness-Organise follow-ups on individual basis | |
| Benzodiazepines (BZD) and BZD-related drugs | -If daytime sedation, cognitive impairment, or psychomotor impairments -In case of both indications: sleep and anxiety disorder |
In general needed | -Monitor: anxiety, insomnia, agitation -Consider monitoring: delirium, seizures, confusion |
| Antipsychotics | -If extrapyramidal or cardiac side effects, sedation, signs of sedation, dizziness, or blurred vision -If given for BPSD or sleep disorder, possibly if given for bipolar disorder |
In general needed | -Monitor: recurrence of symptoms (psychosis, aggression, agitation, delusion, hallucination) -Consider monitoring: insomnia |
| Opioids | -If slow reactions, impaired balance, or sedative symptoms -If given for chronic pain, and possibly if given for acute pain |
In general needed | -Monitor: recurrence of pain -Consider monitoring: musculoskeletal symptoms, restlessness, gastrointestinal symptoms, anxiety, insomnia, diaphoresis, anger, chills |
| Antidepressants | -If hyponatremia, OH, dizziness, sedative symptoms, or tachycardia/arrhythmia -If given for depression but depended on symptom-free time and history of symptoms or given for sleep disorder, and possibly if given for neuropathic pain or anxiety disorder |
In general needed | -Monitor: recurrence of depression, anxiety, irritability and insomnia -Consider monitoring: headache, malaise, gastrointestinal symptoms |
| Antiepileptics | -If ataxia, somnolence, impaired balance, or possibly in case of dizziness -If given for anxiety disorder or neuropathic pain |
Consider | -Monitor: recurrence of seizures -Consider monitoring: anxiety, restlessness, insomnia, headache |
| Diuretics | -If OH, hypotension, or electrolyte disturbance and possibly if urinary incontinence -possibly if given for hypertension |
Consider | -Monitor: heart failure, hypertension, signs of fluid retention |
| Alpha-blockers (AB) used as antihypertensives | -If hypotension, OH, or dizziness | Consider | -Monitor: hypertension -Consider monitoring: palpitations, headache |
| AB for prostate hyperplasia | -If hypotension, OH, or dizziness | In general not needed | -Monitor: return of symptoms |
| Centrally-acting antihypertensives | -If hypotension, OH, or sedative symptoms | Consider | -Monitor: hypertension |
| Sedative antihistamines | -If confusion, drowsiness, dizziness, or blurred vision -In case of all indications: hypnotic/sedative, chronic itch, allergic symptoms |
Consider | -Monitor: return of symptoms -Consider monitoring: insomnia, anxiety |
| Vasodilators used in cardiac diseases | -If hypotension, OH, or dizziness | Consider | -Monitor: symptoms of Angina Pectoris |
| Overactive bladder and incontinence medications | -If dizziness, confusion, blurred vision, drowsiness, or increased QT-interval | Consider | -Monitor: return of symptoms |
aThis column includes answer categories that were chosen by more than 70% of the experts. In addition, after word ‘possibly’ are indicated the categories that were selected by 30–70% of the experts.
b‘In general needed’ indicates that >70% of experts chose categories of yes or depending. ‘Consider’ indicates that 30–70% of experts chose categories of yes or depending. ‘In general not needed’ indicates that <30% of experts chose categories of yes or depending.
c‘Monitor’ refers to >70% of the experts selecting these symptoms. ‘Consider monitoring’ refers to 30–70% of the experts selecting these symptoms. BPSD, behavioural and psychological symptoms of dementia; OH, orthostatic hypotension.