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

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, I-2 = 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, I-2 = 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

Automated summary

The effectiveness of medication review and deprescribing interventions as a single intervention in falls prevention is assessed in this study. The heterogeneity of the interventions prevents an accurate estimation of the exact effect. These interventions should be included in multimodal strategies rather than implemented as stand-alone strategies in falls prevention.