ArticleEuropean geriatric medicine2026
Appraisal of the references supporting the STOPP/START.version 3 criteria.
Article in European geriatric medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed.
- How should evidence be judged for medication optimisation tools? Reflections on Boland et al. and O'Mahony et al.European geriatric medicine · 2026Article
- Response to Boland et al. "Appraisal of the references supporting STOPP/START version 3 criteria".European geriatric medicine · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe 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.
methodsAll 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.
resultsOf 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.
conclusionsFewer 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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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.