Deprescribing fall-risk increasing drugs (FRIDs) for the prevention of falls and fall-related complications: a systematic review and meta-analysis.
Deprescribing fall-risk increasing drugs (FRIDs) for the prevention of falls and fall-related complications: a systematic review and meta-analysis.
复制标题
DOI：
10.1136/bmjopen-2019-035978
复制
发表时间：
2021-02-10
期刊：
影响因子：
2.9
通讯作者：
Holbrook A
中科院分区：
文献类型：
--
作者：
Lee J;Negm A;Peters R;Wong EKC;Holbrook A
由于福尔斯对患者和医疗保健系统造成巨大的健康和经济负担，因此预防福尔斯和与跌倒相关的伤害是一个优先事项。取消被称为“增加跌倒风险的药物”（FRID）的处方药是预防福尔斯的常见策略。我们进行了一项系统评价，以确定其预防福尔斯和跌倒相关并发症的有效性。系统回顾和荟萃分析. MEDLINE、EMBASE、科克伦对照试验中心注册库、CINAHL和灰色文献（自成立至2020年8月1日）。FRID戒断与常规治疗比较的随机对照试验，评价≥65岁成人的福尔斯发生率、福尔斯发生率、跌倒相关损伤、跌倒相关骨折、跌倒相关住院或与干预相关的不良反应。两名评审员独立进行引文筛选、数据提取、偏倚风险评估和证据分级的确定性。随机效应模型用于荟萃分析。5项试验涉及1305名受试者，符合合格标准。取消FRID处方并没有改变福尔斯的跌倒率（率比（RaR）0.98，95%CI 0.63至1.51），福尔斯的发生率（风险差0.01，95% CI-0.06至0.09;相对风险1.04，95% CI 0.86至1.26）或跌倒相关损伤率（RaR 0.89，95% CI 0.57至1.39）。没有试验评估取消FRID处方对跌倒相关骨折或住院的影响。缺乏强有力的高质量证据来支持或反驳FRID取消处方策略单独有效预防老年人福尔斯或跌倒相关损伤。尽管可能有其他原因取消FRID处方，但我们的系统综述发现，作为唯一的福尔斯减少策略，FRID可能导致福尔斯发生率或风险几乎没有差异。CRD 42016040203。
Prevention 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. Systematic review and meta-analysis. MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL and grey literature from inception to 1 August 2020. Randomised 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. Two reviewers independently performed citation screening, data abstraction, risk of bias assessment and certainty of evidence grading. Random-effects models were used for meta-analyses. Five 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. There 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. CRD42016040203.
登录
查看更多内容
影响因子：
6.3
作者：
Florence CS;Bergen G;Atherly A;Burns E;Stevens J;Drake C
通讯作者：
Drake C
影响因子：
15.8
作者：
Moher D;Liberati A;Tetzlaff J;Altman DG;PRISMA Group
通讯作者：
PRISMA Group
DOI：
10.1111/j.1532-5415.1999.tb03843.x
发表时间：
1999-07-01
影响因子：
6.3
作者：
Campbell, AJ;Robertson, MC;Buchner, DM
通讯作者：
Buchner, DM
影响因子：
5
作者：
OLOUGHLIN, JL;ROBITAILLE, Y;SUISSA, S
通讯作者：
SUISSA, S
影响因子：
6.7
作者：
Boye, Nicole D. A.;van der Velde, Nathalie;van der Cammen, Tischa J. M.
通讯作者：
van der Cammen, Tischa J. M.