eTable. Instruments for the identification of potentially inappropriate medication.

Name/last update	Characteristics, structure, and presentation	Comments	Evidence from interventional studies to improve drug therapy safety or clinical endpoints
STOPP/START England/Ireland 2015 (25)	STOPP: Screening tool (80 PIM) by organ and functional system to identify potentially inappropriate medications START: Screening tool (34 recommendations) by organ and functional system to identify potentially necessary medications	Provides the rationale for classification as STOPP and START criterion, complemented by information from NICE guidelines; in a future version, STOPP criteria relevant to falls (STOPP Fall) to be integrated.	Manual screening on hospital admission leads to a reduction in ADRs and length of hospital stay. Computer-generated alerts based on STOPP/START were not effective in the SENATOR trial (e19).
FORTA Germany 2022 (29)	List of the most common pharmaceuticals in long-term use, presented according to areas of indication (e.g., CHD or oncological diseases/solid tumors)	Graded as positive/negative based on four classes (A–D); classes A and B identify potentially necessary medications. Classes C and D identify potentially inadequate medications.	A randomized trial in two German hospitals found significant improvements in adherence to FORTA recommendations through training and weekly meetings with the FORTA team (e16).
PRISCUS Germany 2010 (30)	Negative list (83 PIMs), presented according to medication classes	Information on concerns, alternatives, and measures if use of drugs to be continued. The criteria updated in 2021 will be published shortly (e17).	A cluster-randomized trial (RIME) in 137 German primary care practices found no relevant reduction in PRISCUS-PIM prescriptions through one-off training for primary care physicians or practice teams (e18).
Beers USA 2019 (31)	PIM list (individual medications in 35 drug groups), presented according to organ system and therapeutic category; important interactions with other drugs (n = 17) or underlying diseases or syndromes (n = 10); drugs that are problematic in kidney failure (n = 23); drugs with strong anticholinergic properties (n = 55)	Provides the rationale for classification as a PIM; quality of evidence and strength of recommendation	The D-Prescribe cluster randomized trial (e19) in 69 Canadian pharmacies foundsignificantly more frequent discontinuation of treatment with sedatives/hypnotics, sulfonylureas, and NSAIDs.
STOPP Fall EU/Finland 2021 (32)	Screening tool to identify fall risk increasing drugs (FRIDs), i.e., medication classes that increase the risk of falls (14 medication classes)	Recommendations on the situations in which an attempt at discontinuation should be undertaken, how this should be done where necessary (e.g., tapering), as well as monitoring criteria after discontinuation	To date, there is no explicit evaluation of this tool. However, in a placebo-controlled trial, discontinuation of psychotropic drugs significantly reduced the risk of falls (e20). Nevertheless, according to a recent meta-analysis, the currently available evidence is insufficient to recommend discontinuation of FRIDs alone as a fall prevention strategy (e21).
STOPP Frail 2017 (33)	PIM list (n = 27) to identify PIMs in older persons in whom: – Symptom control is prioritized over prevention or avoidance of disease progression – There is a low 1-year probability of survival – There is irreversible end-stage disease – There is severe functional or cognitive impairment or both categorized according to physiological system	Rationale for categorization as PIM given	Interventional study pending
ACB Score Germany 2018 (34)	Classification of medications available in Germany according to their anticholinergic strength: 29 drugs with strong, 18 withmoderate, and 104 with weak anticholinergic properties	General algorithm for the reduction of anticholinergic burden	In a patient-randomized US trial of 50 patients, a collaboration between physicians and pharmacists significantly reducedanticholinergic load (e23).

Table modified from Moßhammer D, Haumann H, Mörike K, Joos S: Polypharmacy—an upward trend with unpredictable effects. Dtsch Arztebl Int 2016; 113: 627–33.

ACB, anticholinergic burden; FRIDs, fall risk increasing drugs; CHD, coronary heart disease; PIM, potentially inappropriate medication; ADR, adverse drug reaction