Suen Jenni, Narayan Sujita, Seppala Lotta J, van der Velde Nathalie, Sherrington Catherine, Sutcliffe Katy, Cameron Ian D, Kneale Dylan, Dyer Suzanne Marie
Flinders University, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Bedford Park, South Australia, 5042, Australia.
Sydney School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, 2050, Australia.
Age Ageing. 2025 Aug 1;54(8). doi: 10.1093/ageing/afaf230.
Medication review and deprescribing are common fall prevention strategies, as falls risk increasing drugs and polypharmacy are potentially modifiable falls risk factors. We sought to understand why some trials in residential aged care facilities (RACFs) testing medication review/deprescribing reduced falls whilst others did not. We used intervention component analysis (ICA) to develop a theory of the key feature(s) from the trialists' perspective.
Randomised controlled trials (RCTs) evaluating medication review/deprescribing as a single falls prevention intervention in RACFs, were identified via a Cochrane review and additional database searches to 1 April 2025. ICA was conducted with inductive thematic analysis of the Discussion sections of trial publications. Alignment between themes/subthemes and trial outcomes were examined.
Thirteen trials from six countries were included. Trialists perceived that medication review/deprescribing interventions should include a tool (i.e. algorithm/list of medications) to facilitate decisions between clinicians on the appropriateness of resident's prescriptions, with at least one prescriber from the residents' usual care team involved in decisions and implementation of medication changes, reviewing medications together at least 6 monthly. These features were present in 100% (3/3) successful trials and 20% (2/10) unsuccessful trials.
ICA indicated using a tool as a guide amongst clinicians, at least six monthly and including at least one prescriber from the usual care team, could be an important combination of features to improve intervention success. This approach which aligns with recent World Falls Guidelines should be tested in future RCTs of medication optimisation for people living in RACFs.
药物审查和减药是常见的预防跌倒策略，因为增加跌倒风险的药物和多重用药是潜在的可改变的跌倒风险因素。我们试图了解为什么在老年护理机构（RACFs）中进行的一些测试药物审查/减药的试验能减少跌倒，而其他试验却不能。我们从试验者的角度使用干预成分分析（ICA）来构建关键特征的理论。
通过Cochrane综述和截至2025年4月1日的额外数据库搜索，确定在RACFs中评估药物审查/减药作为单一预防跌倒干预措施的随机对照试验（RCTs）。对试验出版物的讨论部分进行归纳主题分析以进行ICA。检查主题/子主题与试验结果之间的一致性。
纳入了来自六个国家的13项试验。试验者认为，药物审查/减药干预应包括一种工具（即药物算法/清单），以促进临床医生之间就居民处方的适宜性做出决策，居民常规护理团队中至少有一名开处方者参与药物变更的决策和实施，至少每6个月一起审查一次药物。这些特征在100%（3/3）成功的试验和20%（2/10）不成功的试验中存在。
ICA表明，在临床医生中使用一种工具作为指导，至少每6个月一次，并且包括常规护理团队中至少一名开处方者，可能是提高干预成功率的重要特征组合。这种与最近的世界跌倒指南一致的方法应在未来针对RACFs居民进行药物优化的RCTs中进行测试。
