Effectiveness of medication withdrawal in older fallers: results from the Improving Medication Prescribing to reduce Risk Of FALLs (IMPROveFALL) trial.
To investigate the effect of withdrawal of fall-risk-increasing-drugs (FRIDs) versus ‘care as usual’ on reducing falls in community-dwelling older fallers.



Randomised multicentre trial



Six hundred and twelve older adults who visited an Emergency Department (ED) because of a fall.



Withdrawal of FRIDs.



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.



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).



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.



Netherlands Trial Register NTR1593.
Department of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.|Section of Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Nicole D A
ND
Boyé
Section of Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Nathalie
N
van der Velde
Department of Internal Medicine, VU University Medical Centre, Amsterdam, The Netherlands.
Oscar J
OJ
de Vries
Department of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Esther M M
EM
van Lieshout
Department of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.|Section of Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Klaas A
KA
Hartholt
Section of Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Francesco U S
FU
Mattace-Raso
Department of Internal Medicine, VU University Medical Centre, Amsterdam, The Netherlands.
Paul
P
Lips
Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Peter
P
Patka
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Ed F
EF
van Beeck
Section of Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Tischa J M
TJ
van der Cammen
D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D015897:Comorbidity; D064420:Drug-Related Side Effects and Adverse Reactions / Q000209:etiology / Q000517:prevention & control*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D057187:Independent Living; D057194:Intention to Treat Analysis; D008297:Male; D054539:Medication Therapy Management; D015999:Multivariate Analysis; D009426:Netherlands; D055553:Prescription Drugs / Q000009:adverse effects*; D016016:Proportional Hazards Models; D012307:Risk Factors; D057566:Self Report; D013997:Time Factors
D055553:Prescription Drugs