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

Journal article (2022)

Authors

L.J. Seppala Amsterdam Public Health Research Institute, Amsterdam UMC
Nelly Kamkar Parkwood Hospital, London Ontario
Eveline P. van Poelgeest Amsterdam Public Health Research Institute, Amsterdam UMC
Katja Thomsen Odense University Hospital, University of Southern Denmark
Joost G. Daams Amsterdam UMC
Jesper Ryg Odense University Hospital, ODIN (Odense Deprescribing INitiative), University of Southern Denmark
T. Masud Nottingham University Hospitals NHS Trust
Manuel Montero-Odasso Parkwood Hospital, London Ontario, University of Western Ontario, Schulich School of Medicine and Dentistry, London Ontario
T.J.M. van der Cammen Applied Ergonomics and Design - IDE
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Research Group
Applied Ergonomics and Design (IDE) (TU Delft)
Copyright: © 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
DOI
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https://doi.org/10.1093/ageing/afac191
Older people Systematic review Accidental falls Medication review Deprescribing Fall-risk-increasing drugs
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Published Date

2022

Language

English

Faculty

Industrial Design Engineering

Department

Human-Centered Design

Research Group

Applied Ergonomics and Design

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