Effectiveness of medication withdrawal in older fallers
results from the Improving Medication Prescribing to reduce Risk Of FALLs (IMPROveFALL) trial
Information
Boyé ND, van der Velde N, de Vries OJ, van Lieshout EM, Hartholt KA, Mattace-Raso FU, Lips P, Patka P, van Beeck EF, van der Cammen TJ;
IMPROveFALL trial collaborators. Age Ageing. 2017 Jan 10;46(1):142-146. doi: 0.1093/ageing/afw161. PMID: 28181639
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Abstract
OBJECTIVES:
To investigate the effect of withdrawal of fall-risk-increasing-drugs (FRIDs) versus ‘care as usual’ on reducing falls in community-dwelling older fallers.
DESIGN:
Randomised multicentre trial
PARTICIPANTS:
Six hundred and twelve older adults who visited an Emergency Department (ED) because of a fall.
INTERVENTIONS:
Withdrawal of FRIDs.
MAIN OUTCOMES AND MEASURES:
Primary outcome was time to the first self-reported fall. Secondary outcomes were time to the second self-reported fall and to falls requiring a general practitioner (GP)-consultation or ED-visit. Intention-to-treat (primary) and a per-protocol (secondary) analysis were conducted. The hazard ratios (HRs) for time-to-fall were calculated using a Cox-regression model. Differences in cumulative incidence of falls were analysed using Poisson regression.
RESULTS:
During 12 months follow-up, 91 (34%) control and 115 (37%) intervention participants experienced a fall; 35% of all attempted interventions were unsuccessful, either due to recurrence of the initial indication for prescribing, additional medication for newly diagnosed conditions or non-compliance. Compared to baseline, the overall percentage of users of ≥3 FRIDs at 12 months did not change in either the intervention or the control group. Our intervention did not have a significant effect on time to first fall (HR 1.17; 95% confidence interval 0.89–1.54), time to second fall (1.19; 0.78–1.82), time to first fall-related GP-consultation (0.66; 0.42–1.06) or time to first fall-related ED-visit (0.85; 0.43–1.68).
CONCLUSION:
In this population of complex multimorbid patients visiting an ED because of a fall, our single intervention of FRIDs-withdrawal was not effective in reducing falls.
TRIAL REGISTRATION:
Netherlands Trial Register NTR1593.