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

Research output: Contribution to journalReview articlepeer-review

15 Scopus citations

Abstract

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.

Original languageEnglish (US)
Article numberafac191
JournalAge and Ageing
Volume51
Issue number9
DOIs
StatePublished - Sep 1 2022

Keywords

  • accidental falls
  • deprescribing
  • fall-risk-increasing drugs
  • medication review
  • older people
  • systematic review

ASJC Scopus subject areas

  • Aging
  • Geriatrics and Gerontology

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