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

Seppala, L. J.; Kamkar, N.; Van Poelgeest, E. P.; Thomsen, K.; Daams, J. G.; Ryg, J.; Masud, T.; Montero-Odasso, M.; Hartikainen, S.; Petrovic, M.; Van Der Velde, N.; Petrovic, M.; Nieuwboer, A.; Vlaeyen, E.; Milisen, K.; Kenny, R. A.; Bourke, R.; Hartikainen, S.; Van Der Cammen, T.; Van Der Velde, N.; Poelgeest, E.; Jellema, A.; Seppala, L. J.; Masud, T.; Todd, C.; Martin, F. C.; Marsh, D. R.; Lamb, S.; Frith, J.; Logan, P.; Skelton, D.; Blain, H.; Anweiller, C.; Freiberger, E.; Becker, C.; Chiari, L.; Cesari, M.; Casas-Herrero, A.; Perez Jara, J.; Alonzo Bouzon, C.; Welmer, A. -K.; Birnghebuam, S.; Kressig, R.; Montero-Odasso, M.; Speechley, M.; Mcilroy, B.; Faria, F.; Sultana, M.; Muir-Hunter, S.; Camicioli, R.; Madden, K.; Norris, M.; Watt, J.; Mallet, L.; Hogan, D.; Verghese, J.; Sejdic, E.; Ferruci, L.; Lipsitz, L.; Ganz, D. A.; Alexander, N. B.; Latham, N. K.; Giber, F.; Schapira, M.; Jauregui, R.; Melgar-Cuellar, F.; Alves Lourenco, R.; Carvalho De Abreu, D. C.; Perracini, M.; Ceriani, A.; Marin-Larrain, P.; Espinola, H. G.; Gomez-Montes, J. F.; Cano-Gutierrez, C. A.; Ulate, X. R.; Picado Ovares, J. E.; Gabriel Buendia, P.; Tito, S. L.; Padilla, D. M.; Aguilar-Navarro, S. G.; Mimenza, A.; Moctezum, R.; Avila-Funes, A.; Gutierrez-Robledo, L. M.; Cornejo Aleman, L. M.; Caona, E. A.; Carbajal, J. C.; Parodi, J. F.; Sgaravatti, A.; Lord, S.; Sherrington, C.; Said, C.; Cameron, I.; Morris, M.; Duque, G.; Close, J.; Kerse, N.; Tan, M. P.; Duan, L.; Sakurai, R.; Wong, C. H.; Muneeb, I.; Negahban, H.; Birimoglu, C.; Won, C. W.; Huasdorff, J.; Kalula, S.; Kobusingye, O.

doi:10.1093/ageing/afac191

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, 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

Medication reviews and deprescribing as a single intervention in falls prevention: a systematic review and meta-analysis / Seppala L.J.; Kamkar N.; Van Poelgeest E.P.; Thomsen K.; Daams J.G.; Ryg J.; Masud T.; Montero-Odasso M.; Hartikainen S.; Petrovic M.; Van Der Velde N.; Petrovic M.; Nieuwboer A.; Vlaeyen E.; Milisen K.; Kenny R.A.; Bourke R.; Hartikainen S.; Van Der Cammen T.; Van Der Velde N.; Poelgeest E.; Jellema A.; Seppala L.J.; Masud T.; Todd C.; Martin F.C.; Marsh D.R.; Lamb S.; Frith J.; Logan P.; Skelton D.; Blain H.; Anweiller C.; Freiberger E.; Becker C.; Chiari L.; Cesari M.; Casas-Herrero A.; Perez Jara J.; Alonzo Bouzon C.; Welmer A.-K.; Birnghebuam S.; Kressig R.; Montero-Odasso M.; Speechley M.; Mcilroy B.; Faria F.; Sultana M.; Muir-Hunter S.; Camicioli R.; Madden K.; Norris M.; Watt J.; Mallet L.; Hogan D.; Verghese J.; Sejdic E.; Ferruci L.; Lipsitz L.; Ganz D.A.; Alexander N.B.; Latham N.K.; Giber F.; Schapira M.; Jauregui R.; Melgar-Cuellar F.; Alves Lourenco R.; Carvalho De Abreu D.C.; Perracini M.; Ceriani A.; Marin-Larrain P.; Espinola H.G.; Gomez-Montes J.F.; Cano-Gutierrez C.A.; Ulate X.R.; Picado Ovares J.E.; Gabriel Buendia P.; Tito S.L.; Padilla D.M.; Aguilar-Navarro S.G.; Mimenza A.; Moctezum R.; Avila-Funes A.; Gutierrez-Robledo L.M.; Cornejo Aleman L.M.; Caona E.A.; Carbajal J.C.; Parodi J.F.; Sgaravatti A.; Lord S.; Sherrington C.; Said C.; Cameron I.; Morris M.; Duque G.; Close J.; Kerse N.; Tan M.P.; Duan L.; Sakurai R.; Wong C.H.; Muneeb I.; Negahban H.; Birimoglu C.; Won C.W.; Huasdorff J.; Kalula S.; Kobusingye O.. - In: AGE AND AGEING. - ISSN 0002-0729. - ELETTRONICO. - 51:9(2022), pp. afac191.1-afac191.12. [10.1093/ageing/afac191]