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

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.

Keywords: accidental falls; deprescribing; fall-risk-increasing drugs; medication review; older people; systematic review.

Figure 1

(a) Forest plot of meta-analysis assessing medication review versus usual care, outcome number of fallers during follow-up. (b) Forest plot of meta-analysis assessing medication review versus usual care, outcome number of injurious fallers during follow-up. ^*Blalock 2020 and Mahlknecht adjusted for clustering by review authors and the totals are design effect corrected totals. (c) Forest plot of meta-analysis assessing medication review versus usual care, outcome number of injurious falls during follow-up. ^*Mahlknecht adjusted for clustering by review authors and the totals are design effect corrected totals.

Figure 2

(a) Forest plot of meta-analysis assessing evaluation of medications according to the FORTA criteria versus usual care, outcome number of fallers during hospital admission. ^*Both trials adjusted for clustering by review authors and the totals are design effect corrected totals. (b) Forest plot of meta-analysis assessing medication review versus usual care, outcome number of fallers after hospital admission. ^*Blum adjusted for clustering by review authors and the totals of Blum are design effect corrected totals.

Figure 3

(a) Forest plot of meta-analysis assessing medication review versus usual care among long-term care facility residents, outcome number of fallers in follow up. (b) Forest plot of meta-analysis assessing medication review versus usual care among long-term care facility residents, outcome number of falls in follow up. ^*Rate ratio of Patterson et al., adjusted for clustering by review authors. All of the totals are complete totals of the trials independent of trial design.