OBJECTIVES To investigate the prevalence of potentially inappropriate prescribing (PIP) according to the revised STOPP/START criteria in older patients with falls and syncope. STUDY DESIGN We included consecutive patients with falls and syncope aged ≥65 years at the day clinic of the Northwest Clinics, the Netherlands, from 2011 to 2016. All medication use before and after the visit was retrospectively investigated using the revised STOPP/START criteria. MAIN OUTCOME MEASURES The prevalence/occurrence of PIP before the visit, persistent PIP after the visit, and unaddressed persistent PIP not explained in the patient's chart. RESULTS PIP was present in 98 % of 374 patients (mean age 80 (SD ± 7) years; 69 % females). 1564 PIP occurrences were identified. 1015 occurrences persisted (in 91 % of patients). 690 occurrences (in 80 % of patients) were not explained in the patient's chart. The most frequent unaddressed persistent forms of PIP were prescriptions of vasodilator drugs for patients with orthostatic hypotension (16 %), and benzodiazepines for >4 weeks (10 %) or in fall patients (8 %), and omission of vitamin D (28 %), antihypertensive drugs (24 %), and antidepressants (17 %). 54 % of all medication changes were initiated for reasons beyond the scope of the STOPP/START criteria. CONCLUSIONS Almost every patient in our study population suffered from PIP. In 80 %, PIP continued after the clinical visit, without an explanation in the patient's chart. The most frequent PIP concerned medication that increased the risk of falls or syncope, specifically vasodilator drugs and benzodiazepines. Physicians should be aware of PIP in older patients with falls and syncope. Further studies should investigate whether a structured medication review may improve clinical outcomes.

中文翻译：

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停止还是开始？老年跌倒和晕厥患者可能不适当的处方

目的 根据修订后的 STOPP/START 标准，调查老年跌倒和晕厥患者潜在不适当处方 (PIP) 的发生率。研究设计 我们纳入了 2011 年至 2016 年在荷兰 Northwest Clinics 日间诊所的连续跌倒和晕厥患者，年龄≥65 岁。使用修订后的 STOPP/START 标准对访问前后的所有药物使用情况进行回顾性调查。主要观察指标 访视前 PIP、访视后持续性 PIP 和未解决的持续性 PIP 的患病率/发生率未在患者图表中解释。结果 374 名患者中有 98% 存在 PIP（平均年龄 80 (SD ± 7) 岁；69% 女性）。确定了 1564 个 PIP 事件。1015 次持续发生（在 91% 的患者中）。690 次发生（80% 的患者）未在患者图表中解释。最常见的未解决的持续性 PIP 形式是为直立性低血压患者开具血管扩张药处方 (16 %) 和 4 周以上 (10 %) 或跌倒患者 (8 %) 的苯二氮卓类药物，以及省略维生素 D (28 %) )、抗高血压药 (24%) 和抗抑郁药 (17%)。54% 的药物变更是由于超出 STOPP/START 标准范围的原因而启动的。结论 我们研究人群中几乎所有患者都患有 PIP。80% 的患者在临床访视后继续进行 PIP，患者图表中没有解释。最常见的 PIP 与增加跌倒或晕厥风险的药物有关，特别是血管扩张药和苯二氮卓类药物。医生应了解老年跌倒和晕厥患者的 PIP。进一步的研究应该调查结构化药物审查是否可以改善临床结果。