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Purpose STOPP/START is a physiological systems-based explicit set of criteria that attempts to define the clinically important prescribing problems relating to potentially inappropriate medications (PIMs–STOPP criteria) and potential prescribing omissions (PPOs–START criteria). The previous two versions of STOPP/START criteria were published in 2008 and 2015. The present study describes the revised and updated third version of the criteria. Methods A detailed system-by-system review of the published literature from April 2014 to March 2022 was undertaken with the aim of including clinically important new explicit PIM and PPO criteria and removing any criteria considered to be no longer correct or outdated. A panel of 11 academic physicians with recognized expertise in geriatric pharmacotherapy from 8 European countries participated in a Delphi panel with the task of validating the draft criteria. The panel was presented with the draft new criteria using the SurveyMonkey® on-line platform in which panelists were asked to indicate their level of agreement on a five-point Likert scale. Results Two hundred and four evidence-based draft criteria (one hundred and forty-five STOPP criteria, fifty-nine START criteria) were presented to panelists for assessment using the Delphi validation method. Over the course of four rounds of Delphi validation, the panel achieved consensus on 133 STOPP criteria and 57 START criteria, i.e., 190 STOPP/START criteria in total representing a 66.7% increase in the number of criteria compared to STOPP/START version 2 published in 2015. Conclusion A fully revised and updated version of STOPP/START criteria has been validated by a European expert panel using the Delphi consensus process.

This systematic review aimed to determine if non-pharmacological interventions can impact upon older stroke survivors quality of life. From 28 trials we identified limited evidence supporting a beneficial impact upon quality of life from additional physiotherapy and occupational therapy. Very limited evidence supported the use of a wide array of other non-pharmacological therapies. Current evidence is limited by low study quality and small sample sizes and more trials specifically involving older stroke survivors are required. The efficacy of non-pharmacological stroke rehabilitation approaches for older stroke survivors is largely unknown, particularly in relation to psychosocial outcomes such as quality of life. This systematic review examined the evidence for such interventions as part of the Optimal Evidence-Based Non-Drug Therapies in Older Persons (ONTOP) project conducted under an European Union funded project called the Software Engine for the Assessment and Optimisation of Drug and Non-Drug Therapies in Older Persons (SENATOR) [ http://www.senator-project.eu ]. Thirteen experts in geriatric medicine, as part of a Delphi panel, agreed quality of life to be a critical outcome of stroke rehabilitation. A comprehensive search strategy was developed and databases were searched for eligible systematic reviews from which trials meeting our criteria were identified. Eligible papers were then double reviewed. Due to heterogeneity, narrative analysis was performed. Cochrane risk of bias and GRADE assessment tools were used to assess bias and quality of evidence. We identified 28 trials, spanning ten types of intervention. Limited evidence supports the use of additional occupational therapy and physiotherapy, with very limited evidence supporting our recommendation to explore caregiver training, constraint-induced movement therapy, device-assisted physiotherapy, and self-management education further. Limited evidence suggests a range of non-pharmacological interventions may improve the quality of life of older stroke survivors. However, evidence is limited by low study quality and the small number of studies targeting older stroke survivors. We recommend future studies explore such interventions exclusively in older adult populations and improve methodological and outcome reporting.

Aim To provide an updated overview of studies on under-prescription in older subjects, describing its prevalence, causes, consequences as well as potential interventions to reduce it. Findings Under-prescription is common in older patients and associated with negative clinical outcomes, such as higher risk of cardiovascular events, worsening disability, hospitalization and death. Promising interventions to correct it include the implementation of explicit under-prescription criteria, the use of comprehensive geriatric assessment by geriatricians, and the involvement of a clinical pharmacist. Message Further studies should be performed to provide a better understanding of under-prescription and to confirm the efficacy of corrective interventions. Under-prescription is defined as the omission of a medication that is indicated for the treatment of a condition or a disease, without any valid reason for not prescribing it. The aim of this review is to provide an updated overview of under-prescription, summarizing the available evidence concerning its prevalence, causes, consequences and potential interventions to reduce it. A PubMed search was performed, using the following keywords: under-prescription; under-treatment; prescribing omission; older adults; polypharmacy; cardiovascular drugs; osteoporosis; anticoagulant. The list of articles was evaluated by two authors who selected the most relevant of them. The reference lists of retrieved articles were screened for additional pertinent studies. Although several pharmacological therapies are safe and effective in older patients, under-prescription remains widespread in the older population, with a prevalence ranging from 22 to 70%. Several drugs are underused, including cardiovascular, oral anticoagulant and anti-osteoporotic drugs. Many factors are associated with under-prescription, e.g. multi-morbidity, polypharmacy, dementia, frailty, risk of adverse drug events, absence of specific clinical trials in older patients and economic factors. Under-prescription is associated with negative consequences, such as higher risk of cardiovascular events, worsening disability, hospitalization and death. The implementation of explicit criteria for under-prescription, the use of the comprehensive geriatric assessment by geriatricians, and the involvement of a clinical pharmacist seem to be promising options to reduce under-prescription. Under-prescription remains widespread in the older population. Further studies should be performed, to provide a better comprehension of this phenomenon and to confirm the efficacy of corrective interventions.

Objectives To develop explicit evidence-based recommendations for non-pharmacological interventions to prevent falls in older subjects using the GRADE approach to rate the quality of evidence and the strength of recommendations. Methods A multidisciplinary panel was constituted composed of geriatricians, a research nurse and a clinical epidemiologist. The GRADE approach was used to rate the evidence and to formulate recommendations. Results The critical outcomes were fall rate and number of fallers. Forty-five clinical questions and the associated recommendations were formulated for single, multiple and multifactorial non-pharmacological interventions in three different settings (home, care facilities and hospitals). Seven strong recommendations in favour, and one strong recommendation against, were formulated, all of which were supported by moderate-quality evidence. The remaining 37 clinical questions had weak recommendations. A strong recommendation was formulated in favour of exercise, as a single component, in groups and individually, for community-dwelling older people. Tai Chi was strongly recommended for older adults at risk of falling, living at home. Home safety assessment and modification was strongly recommended for older adults living at home and at high risk of falling. Multifactorial interventions were strongly recommended for older adults, at high risk of falling, living at home and, in older adults in care facilities and hospitals, while knowledge/education alone was strongly recommended against for older people at home. Conclusions Based on a systematic review of the evidence, 45 recommendations were formulated regarding non-pharmacological interventions to prevent falls in older adults living at home, in care facilities and in hospitals.

Delirium is a severe neuropsychiatric syndrome characterized by inattention and global cognitive dysfunction in the setting of an acute medical illness, medical complication, drug intoxication or drug withdrawal. The most important risk factors are advanced age and dementia whereas pain, dehydration, infections, stroke, metabolic disturbances, and surgery are the most common triggering factors. Although delirium is a common clinical syndrome in different setting of care (acute care hospitals, inpatient rehabilitation facilities, nursing homes, and hospices) it often remains under-recognised, poorly understood and not adequately managed then there exists a clear need for improved understanding to overcome cultural stereotypes and for the development and dissemination of a comprehensive model of implementation of general good practice points. A network of Italian national scientific societies was thus convened (1) to develop a collaborative multidisciplinary initiative report on delirium in the elderly hospitalized patients, (2) to focus the attention of health care personnel on prevention, diagnosis and therapy of patients suffering from delirium, and (3) to make the health services research community and policy-makers more aware of the potential risks of this condition providing a reference for training activities and data collection.

Physical function decreases with aging leading to a wide spectrum of negative outcomes, such as mobility disability, falls, social isolation, reduced quality of life, dependency and institutionalization. The age-related loss of physical performance typically results from multiple clinical and subclinical conditions. The clinical picture of frailty (especially when assessed using instruments focused on the physical function domain) shows remarkable overlap with that of sarcopenia (“a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength with a risk of adverse outcomes such as physical disability, poor quality of life and death”). In this paper, the conceptualisation of sarcopenia as the biological substrate of physical frailty is illustrated. It is also elaborated that sarcopenia may be envisioned as the pathophysiologic pathway through which the negative health-related outcomes of physical frailty develop.

Introduction: Grip strength is a well-accepted measure of muscle strength. A standardized protocol for the measurement of grip strength has been proposed in 2011 to enable consistent measurement of grip strength and comparisons between studies. It is unknown whether this protocol has been adopted in sarcopenia research and practice. The aim of the study was to provide insight into current measurement practice, including the use of cut-off values for low muscle strength. Methods: A systematic review of the literature was conducted, followed by a methodological quality assessment and extraction of relevant data. Inclusion criteria included a description of the grip strength protocol, EWGSOP standards were used to define sarcopenia, data was collected after 2010 and participants were 65 years and older. Results: Twenty-seven observational papers were included in the review. The methodological quality was acceptable/good. Overall, information about the protocol was limited with a large variability in measurement approach. Most non-Asian studies used cut-off values for low grip strength of 30 kg for men and 20 kg for women. Asian studies showed more variability in choice of cut-off values. Discussion: The proposed grip strength measurement protocol has been poorly adopted since its publication. Although there seems to be some agreement on cut-off values in non-Asian studies, proposed cut-off values need to be evaluated in specific diseases and settings and its predictive abilities regarding outcomes such as mobility limitations and falls needs to be determined. Asian research on cut-off values is still ongoing.

The efficacy of non-pharmacological stroke rehabilitation approaches for older stroke survivors is largely unknown, particularly in relation to psychosocial outcomes such as quality of life. This systematic review examined the evidence for such interventions as part of the Optimal Evidence-Based Non-Drug Therapies in Older Persons (ONTOP) project conducted under an European Union funded project called the Software Engine for the Assessment and Optimisation of Drug and Non-Drug Therapies in Older Persons (SENATOR) [ http://www.senator-project.eu ].Thirteen experts in geriatric medicine, as part of a Delphi panel, agreed quality of life to be a critical outcome of stroke rehabilitation. A comprehensive search strategy was developed and databases were searched for eligible systematic reviews from which trials meeting our criteria were identified. Eligible papers were then double reviewed. Due to heterogeneity, narrative analysis was performed. Cochrane risk of bias and GRADE assessment tools were used to assess bias and quality of evidence.We identified 28 trials, spanning ten types of intervention. Limited evidence supports the use of additional occupational therapy and physiotherapy, with very limited evidence supporting our recommendation to explore caregiver training, constraint-induced movement therapy, device-assisted physiotherapy, and self-management education further.Limited evidence suggests a range of non-pharmacological interventions may improve the quality of life of older stroke survivors. However, evidence is limited by low study quality and the small number of studies targeting older stroke survivors. We recommend future studies explore such interventions exclusively in older adult populations and improve methodological and outcome reporting.

O 001 Orthostatic hypotension is associated with cognitive performance only in middle aged and older adults with supine hypertension J. Frewena,b,c,d, C. Finucanea,b,c,d, G.M. Savvaa,b,c,d, G. Boylea,b,c,d, R.A. Kennya,b,c,d a The Irish longitudinal study on ageing, Lincoln gate, Trinity College, Dublin 2, Ireland b Department of Medical Physics and Bioengineering, St. James’s Hospital, Dublin 8, Ireland c Mercer’s Institute for Research on Ageing, St. James’s Hospital, Dublin 8, Ireland d Trinity College Institute of Neuroscience, Trinity College, Dublin 2, Ireland