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251211BBolandAppraisaloftheSTOPP-STARTv3references_EGMinpress.pdf
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Background: The strength of evidence underlying the STOPP/START version 3 (SS.v3) criteria has not been reported and remains controversial, potentially limiting their clinical implementation. This study aimed at appraising the references provided for the SS.v3 criteria. Methods: All references cited for the 190 SS.v3 criteria were evaluated and discussed by a clinical pharmacist–geriatrician pair and a geriatrician expert in literature appraisal who reached agreement. The main endpoint was the evidence level classified by data study design (level I: randomised controlled trials; II: cohort studies; III: case–control; IV: case series; V: expert opinion). References were classified as inappropriate if they showed mismatch, lacked supporting content, or were clinically discordant with the criterion. Results: Of the 454 SS.v3 references, 322 are reviews (STOPP 70%, START 71%), either systematic (STOPP 29%, START 44%) or narrative (STOPP 41%, START 26%). Evidence is level I (STOPP 28%, START 64%), level II (STOPP 13%, START 8%), levels III–IV–V (STOPP 45%, START 19%), or downgraded because of inappropriateness (STOPP 15%, START 8%). At the level of the 190 criteria, the best evidence is level I (STOPP 43%, START 88%), level II (STOPP 13%, START 7%), levels III–IV–V (STOPP 35%, START 4%), while 10 criteria (STOPP 8%, START 0%) lack appropriate supporting reference. Conclusions: Fewer than half of the STOPP criteria are supported by high-level evidence, unlike most START criteria. A reassessment of many STOPP criteria and their references is warranted. Clinicians should be aware of these limitations when involving in shared decision-making with older patients.
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Boland, B., Sibille, F.-X., Mouzon, A., Marien, S., Vaillant, F., Spinewine, A., & Dalleur, O. (2025). Appraisal of the references supporting the STOPP/START.version 3 criteria. European Geriatric Medicine. Published. https://doi.org/10.1007/s41999-025-01386-7 (Original work published 2025)