Deprescribing fall-risk increasing drugs (FRIDs) for the prevention of falls and fall-related complications: a systematic review and meta-analysis

• Published in: BMJ open 2021-02, Vol.11 (2), p.e035978
• Main Authors: Lee, Justin, Negm, Ahmed, Peters, Ryan, Wong, Eric K C, Holbrook, Anne
• Format: Article
• Language: English
• Subjects: Accident prevention; Accidental Falls - prevention & control; Accreditation; Aged; Bias; clinical pharmacology; Deprescriptions; Drug withdrawal; Drugs; Estimates; Falls; Fractures, Bone - prevention & control; Geriatric Medicine; Handbooks; Health risks; Hospitalization; Humans; Initiatives; Injuries; Injury prevention; internal medicine; Intervention; Meta-analysis; Older people; Patients; Pharmaceutical Preparations; Prevention; primary care; Public health; Sensitivity analysis; Systematic review
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2019-035978

ObjectivesPrevention of falls and fall-related injuries is a priority due to the substantial health and financial burden of falls on patients and healthcare systems. Deprescribing medications known as ‘fall-risk increasing drugs’ (FRIDs) is a common strategy to prevent falls. We conducted a systematic review to determine its efficacy for the prevention of falls and fall-related complications.DesignSystematic review and meta-analysis.Data sourcesMEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL and grey literature from inception to 1 August 2020.Eligibility criteria for selecting studiesRandomised controlled trials of FRID withdrawal compared with usual care evaluating the rate of falls, incidence of falls, fall-related injuries, fall-related fractures, fall-related hospitalisations or adverse effects related to the intervention in adults aged ≥65 years.Data extraction and synthesisTwo reviewers independently performed citation screening, data abstraction, risk of bias assessment and certainty of evidence grading. Random-effects models were used for meta-analyses.ResultsFive trials involving 1305 participants met eligibility criteria. Deprescribing FRIDs did not change the rate of falls (rate ratio (RaR) 0.98, 95% CI 0.63 to 1.51), the incidence of falls (risk difference 0.01, 95% CI −0.06 to 0.09; relative risk 1.04, 95% CI 0.86 to 1.26) or rate of fall-related injuries (RaR 0.89, 95% CI 0.57 to 1.39) over a follow-up period of 6–12 months. No trials evaluated the impact of deprescribing FRIDs on fall-related fractures or hospitalisations.ConclusionThere is a paucity of robust high-quality evidence to support or refute that a FRID deprescribing strategy alone is effective at preventing falls or fall-related injury in older adults. Although there may be other reasons to deprescribe FRIDs, our systematic review found that it may result in little to no difference in the rate or risk of falls as a sole falls reduction strategy.PROSPERO registration numberCRD42016040203.