Introduction: Deprescribing opportunities may differ across health care systems, aged care settings, and prescribing cultures.

Objective: To compare the prevalence of STOPPFrail medications according to frailty status among residents in Australian, Chinese, Japanese, and Spanish aged care facilities.

Methods: Secondary cross-sectional analyses of data from four cohort studies (n=1,142; 31 facilities). Medication data were extracted from resident records. Frailty was assessed using the FRAIL-NH scale (non-frail 0–2; frail 3–6; most-frail 7–14). Chi-square tests and prevalence ratios (PRs) were used to compare STOPPFrail medication use across cohorts.

Results: In total, 84.7% of non-frail, 95.6% of frail, and 90.6% of most-frail residents received ≥1 STOPPFrail medication. Overall, the most prevalent STOPPFrail medications were antihypertensives (53.0-73.3%), vitamin D (nil-52.7%), statins (11.1-38.9%), aspirin (13.5-26.2%), proton pump inhibitors (2.1-32.0%), and diabetes medications (12.3-23.5%). Overall use of antihypertensives (PR 1.15[95%CI, 1.06–1.25]), statins (PR 1.78[95%CI, 1.45–2.18]), aspirin (PR 1.31[95%CI, 1.04–1.64]), and diabetes medications (PR 1.3[95% CI, 1.00–1.72]) were more prevalent among non-frail and frail residents compared with most-frail residents. Antihypertensive use was more prevalent with increasing frailty in China and Japan, but less prevalent with increasing frailty in Australia. Diabetes medication use was less prevalent with increasing frailty in China and Spain but was consistent across frailty groups in Australia and Japan.

Conclusion: There were overall and frailty-specific variations in prevalence of different STOPPFrail medications across cohorts. This may reflect differences in prescribing cultures, application of clinical guidelines in the aged care setting, and clinician or resident attitudes toward deprescribing.