Title
Medication reviews and deprescribing as a single intervention in falls prevention: a systematic review and meta-analysis
Author
Seppala, L.J. (Amsterdam UMC; Amsterdam Public Health Research Institute)
Kamkar, Nelly (Parkwood Hospital, London Ontario)
van Poelgeest, Eveline P. (Amsterdam UMC; Amsterdam Public Health Research Institute)
Thomsen, Katja (Odense University Hospital; University of Southern Denmark)
Daams, Joost G. (Amsterdam UMC)
Ryg, Jesper (Odense University Hospital; University of Southern Denmark; ODIN (Odense Deprescribing INitiative))
Masud, T. (Nottingham University Hospitals NHS Trust)
Montero-Odasso, Manuel (University of Western Ontario; Parkwood Hospital, London Ontario; Schulich School of Medicine and Dentistry, London Ontario)
van der Cammen, T.J.M. (TU Delft Applied Ergonomics and Design) 
Date
2022
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, I 2 = 37%, 3 s) for number of injurious fallers and in a rate ratio (RaR) of 0.89 (0.69–1.14, I 2 = 0%, 2 s) for injurious falls.
Hospital: meta-analyses assessing medication reviews resulted in an RR = 0.97 (0.74–1.28, I 2 = 15%, 2 s) and in an RR = 0.50 (0.07–3.50, I 2 = 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, I 2 = 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
Subject
accidental falls
medication review
deprescribing
fall-risk-increasing drugs
older people
systematic review
To reference this document use:
http://resolver.tudelft.nl/uuid:b38e1135-c1fd-4fa4-9907-361f7f4a4759
DOI
https://doi.org/10.1093/ageing/afac191
ISSN
0002-0729
Source
Age and Ageing, 51 (9)
Part of collection
Institutional Repository
Document type
journal article
Rights
© 2022 L.J. Seppala, Nelly Kamkar, Eveline P. van Poelgeest, Katja Thomsen, Joost G. Daams, Jesper Ryg, T. Masud, Manuel Montero-Odasso, T.J.M. van der Cammen, More Authors