Medication reviews and deprescribing as a single intervention in falls prevention: a systematic review and meta-analysis

Lotta J Seppala, Nellie Kamkar, Eveline P van Poelgeest, Katja Thomsen*, Joost G Daams, Jesper Ryg, Tahir Masud, Manuel Montero-Odasso, Sirpa Hartikainen, Mirko Petrovic, Nathalie van der Velde, Task Force on Global Guidelines for Falls in Older Adults

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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Abstract

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

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.

Original languageEnglish
Article numberafac191
JournalAge and Ageing
Volume51
Issue number9
ISSN1468-2834
DOIs
Publication statusPublished - 2. Sept 2022

Bibliographical note

© The Author(s) 2022. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Keywords

  • Deprescriptions
  • Exercise
  • Hospitals
  • Humans
  • Medication Review
  • medication review
  • accidental falls
  • fall-risk-increasing drugs
  • older people
  • deprescribing
  • systematic review

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