Medication reviews and deprescribing as a single intervention in falls prevention: a systematic review and meta-analysis
L.J. Seppala (Amsterdam Public Health Research Institute, Amsterdam UMC)
Nelly Kamkar (Parkwood Hospital, London Ontario)
Eveline P. van Poelgeest (Amsterdam UMC, Amsterdam Public Health Research Institute)
Katja Thomsen (University of Southern Denmark, Odense University Hospital)
Joost G. Daams (Amsterdam UMC)
Jesper Ryg (ODIN (Odense Deprescribing INitiative), University of Southern Denmark, Odense University Hospital)
T. Masud (Nottingham University Hospitals NHS Trust)
Manuel Montero-Odasso (University of Western Ontario, Schulich School of Medicine and Dentistry, London Ontario, Parkwood Hospital, London Ontario)
T.J.M. van der Cammen (TU Delft - Industrial Design Engineering)
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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.
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
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