Potentially inappropriate prescribing and falls-risk increasing drugs in people who have experienced a fall; a systematic review and meta-analysis.

BackgroundAs certain medications increase risk of falls, it is important to review and optimise prescribing in those who have fallen to reduce risk of recurrent falls. ObjectivesTo systematically review evidence on the prevalence and types of potentially inappropriate prescribing (PIP), including falls-risk increasing drug (FRID) use, in fallers. MethodsA systematic search was conducted in July 2024 in MEDLINE, EMBASE, CINAHL, and Google Scholar using keywords for fall events, inappropriate prescribing, and FRIDs. Observational studies (cohort, case-control, cross-sectional, before-after) and randomised trials were included. Studies were eligible where participants had experienced a fall and PIP (including FRID use) was reported. Random-effects meta-analyses were conducted to pool prevalence of inappropriate prescribing and mean number of inappropriate prescriptions across studies, with stratified analysis to assess heterogeneity. ResultsFifty papers reporting 46 studies met the inclusion criteria. All studies assessed FRIDs, and twenty-nine assessed other PIP. The prevalence of PIP at the time of the fall was reported in 43 studies, and the pooled estimate was 68.6% (95%CI 66.1-71.2%). Among 23 studies reporting it, the mean number of inappropriate prescriptions per participant was 2.21 (95%CI 1.98-2.45). The most common FRIDs prescribed were sedatives/hypnotics, opioids, diuretics, and antidepressants. Twenty-one studies assessed changes in PIP prevalence post-fall; nine reported decreasing prevalence, with others noting increases/no change/mixed results. ConclusionInappropriate prescribing is highly prevalent among fallers, with cardiovascular and psychotropic drugs being the most common. This suggests significant scope to optimise medicines use in these patients to potentially reduce falls risk and improve outcomes.