DOES DEPRESCRIBING FALL-ASSOCIATED DRUGS REDUCE FALLS AND ITS COMPLICATIONS?: A SYSTEMATIC REVIEW

Falls are the leading cause of injury and injury-related hospitalizations for seniors in Canada with annual healthcare costs exceeding $2 billion. Despite limited evidence of effectiveness, the withdrawal (discontinuation or dose reduction) of “fall-risk increasing drugs” (FRIDs) is typically part of falls prevention strategies and hospital accreditation initiatives. The study objectives were to determine the preventative efficacy of FRID withdrawal on falls and fall-related complications. An electronic search was conducted in MEDLINE, EMBASE, CENTRAL and CINAHL. A grey literature search included trial registries and conference abstracts. All randomized controlled trials in adults age ≥ 65 evaluating FRID withdrawal compared to usual care on falls rate or incidence, fall-related injuries, fractures or hospitalizations and/or adverse effects related to the intervention were included. Two reviewers independently screened eligible studies, abstracted data and assessed risk of bias. The GRADE criteria were used to rate overall confidence in effect estimates for outcomes. Five trials involving 1309 participants met eligibility criteria for inclusion. A FRID withdrawal strategy did not significantly change the rate of falls (RaR 0.98, 95% CI 0.63 to 1.51), number of fallers (RR 1.06, 95% CI 0.84 to 1.34) or rate of fall-related injuries (RaR 0.89, 95% CI 0.57 to 1.39) over a 6 to 12 month follow-up period. There is insufficient evidence that a FRID withdrawal strategy is effective for preventing falls. Based on very low quality evidence, it is uncertain whether FRID withdrawal leads to any appreciable clinically important benefit. Data evaluating the potential harms of FRID withdrawal is lacking.