Medication reviews and deprescribing as a single intervention in falls prevention: a systematic review and meta-analysis
Authors: Seppala Lotta J , Kamkar Nellie , van Poelgeest Eveline P , Thomsen Katja , Daams Joost G , Ryg Jesper , Masud Tahir , Montero-Odasso Manuel , Hartikainen Sirpa , Petrovic Mirko , van der Velde Nathalie ,   the Task Force on Global Guidelines for Falls in Older Adults, Petrovic Mirko , Nieuwboer Alice , Vlaeyen Ellen , Milisen Koen , Ryg Jesper , Kenny Rose Anne , Bourke Robert , Hartikainen Sirpa , Van der Cammen Tischa , van der Velde Nathalie , Poelgeest Eveline , Jellema Anton , Seppala Lotta J , Masud Tahir , Todd Chris , Martin Finbarr C , Marsh David R , Lamb Sallie , Frith James , Logan Pip , Skelton Dawn , Blain Hubert , Anweiller Cedric , Freiberger Ellen , Becker Clemens , Chiari Lorenzo , Cesari Matteo , Casas-Herrero Alvaro , Perez Jara Javier , Alonzo Bouzòn Christina , Welmer Ana-Karim , Birnghebuam Stephanie , Kressig Reto , Montero-Odasso Manuel , Speechley Mark , McIlroy Bill , Faria Frederico , Sultana Munira , Muir-Hunter Susan , Camicioli Richard , Madden Kenneth , Norris Mireille , Watt Jennifer , Mallet Louise , Hogan David , Verghese Joe , Sejdic Ervin , Ferrucci Luigi , Lipsitz Lewis , Ganz David A , Alexander Neil B , Latham Nancy Kathryn , Giber Fabiana , Schapira Marcelo , Jauregui Ricardo , Melgar-Cuellar Felipe , Alves Lourenço Roberto , Carvalho de Abreu Daniela Cristina , Perracini Monica , Ceriani Alejandro , Marín-Larraín Pedro , Espinola Homero Gac , Gómez-Montes José Fernando , Cano-Gutierrez Carlos Alberto , Ulate Xinia Ramirez , Picado Ovares José Ernesto , Gabriel Buendia Patricio , Tito Susana Lucia , Padilla Diego Martínez , Aguilar-Navarro Sara G , Mimenza Alberto , Moctezum Rogelio , Avila-Funes Alberto , Gutiérrez-Robledo Luis Miguel , Cornejo Alemán Luis Manuel , Caona Edgar Aguilera , Carbajal Juan Carlos , Parodi José F , Sgaravatti Aldo , Lord Stephen , Sherrington Cathie , Said Cathy , Cameron Ian , Morris Meg , Duque Gustavo , Close Jacqueline , Kerse Ngaire , Tan Maw Pin , Duan Leilei , Sakurai Ryota , Wong Chek Hooi , Muneeb Irfan , Negahban Hossein , Birimoglu Canan , Won Chang Won , Huasdorff Jeffrey , Kalula Sebastiana , Kobusingye Olive 
Published: September 2022

Background

our aim was to assess the effectiveness of medication review and deprescribing interventions as a single intervention in falls prevention.

Methods

 

Design

systematic review and meta-analysis.

Data sources

Medline, Embase, Cochrane CENTRAL, PsycINFO until 28 March 2022.

Eligibility criteria

randomised controlled trials of older participants comparing any medication review or deprescribing intervention with usual care and reporting falls as an outcome.

Study records

title/abstract and full-text screening by two reviewers.

Risk of bias

Cochrane Collaboration revised tool.

Data synthesis

results reported separately for different settings and sufficiently comparable studies meta-analysed.

Results

forty-nine heterogeneous studies were included.

Community

meta-analyses of medication reviews resulted in a risk ratio (RR) of 1.05 (95% confidence interval, 0.85–1.29, I2 = 0%, 3 studies(s)) for number of fallers, in an RR = 0.95 (0.70–1.27, I2 = 37%, 3 s) for number of injurious fallers and in a rate ratio (RaR) of 0.89 (0.69–1.14, I2 = 0%, 2 s) for injurious falls.

Hospital

meta-analyses assessing medication reviews resulted in an RR = 0.97 (0.74–1.28, I2 = 15%, 2 s) and in an RR = 0.50 (0.07–3.50, I2 = 72% %, 2 s) for number of fallers after and during admission, respectively.

Long-term care

meta-analyses investigating medication reviews or deprescribing plans resulted in an RR = 0.86 (0.72–1.02, I2 = 0%, 5 s) for number of fallers and in an RaR = 0.93 (0.64–1.35, I2 = 92%, 7 s) for number of falls.

Conclusions

the heterogeneity of the interventions precluded us to estimate the exact effect of medication review and deprescribing as a single intervention. For future studies, more comparability is warranted. These interventions should not be implemented as a stand-alone strategy in falls prevention but included in multimodal strategies due to the multifactorial nature of falls.

PROSPERO registration number: CRD42020218231