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 Petrović, Nathalie van der Velde, the Task Force on Global Guidelines for Falls in Older Adults, Mirko Petrović, Alice Nieuwboer, Ellen Vlaeyen, Koen Milisen, Jesper Ryg, Rose Anne Kenny, Robert D. Bourke, Sirpa Hartikainen, Tischa van der Cammen, Nathalie van der Velde, Eveline P. van Poelgeest, A. Jellema, Lotta J Seppala, Tahir Masud, Chris Todd, Finbarr C. Martin, David Marsh, Sallie Lamb, James Frith, Pip Logan, Dawn A. Skelton, Hubert Blain, Cedric Anweiller, Ellen Freiberger, Clemens Becker, Lorenzo Chiari, Matteo Cesari, Álvaro Casas‐Herrero, Javier Perez Jara, Christina Alonzo Bouzòn, Ana-Karim Welmer, Stephanie Birnghebuam, Reto W. Kressig, Manuel Montero‐Odasso, Mark Speechley, Bill McIlroy, Frederico Faria, Munira Sultana, Susan Hunter, Richard Camicioli, Kenneth Madden, Mireille Norris, Jennifer Watt, Louise Mallet, David B. Hogan, Joe Verghese, Ervin Sejdić, Luigi Ferrucci, Lewis A. Lipsitz, David A. Ganz, Neil B. Alexander, Nancy K. Latham, Fabiana Giber, Marcelo Schapira, Ricardo Jauregui, Felipe Melgar-Cuellar, Roberto Alves Lourenço, Daniela Cristina Carvalho de Abreu, Mônica Rodrigues Perracini, Alejandro Ceriani, Pedro Marín-Larraín, Homero Gac Espinola, José Fernando Gómez-Montes, Carlos Cano, Xinia Ramirez Ulate, José 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 Gutiérrez‐Robledo, Luis Manuel Cornejo Alemán, Edgar Aguilera Caona, Juan Carlos Carbajal, José F. Parodi, Aldo Sgaravatti, Stephen R. Lord, Cathie Sherrington, Cathy Said, Ian D. Cameron, Meg E. Morris, Gustavo Duque, Jacqueline Close, Ngaire Kerse, Maw Pin Tan
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.