title: The efficacy of fall-risk-increasing drug (FRID) withdrawal for the prevention of falls and fall-related complications: protocol for a systematic review and meta-analysis.
abstract: Despite limited evidence of effectiveness, withdrawal (discontinuation or dose reduction) of high risk medications known as "fall-risk increasing drugs" (FRIDs) is typically conducted as a fall prevention strategy based on presumptive benefit. Our objective is to determine the efficacy of fall-risk increasing drugs (FRIDs) withdrawal on the prevention of falls and fall-related complications.
  
  
  
  We will search for all published and unpublished randomized controlled trials evaluating the effect of FRID withdrawal compared to usual care on the rate of falls, incidence of falls, fall-related injuries, fall-related fractures, fall-related hospitalizations, or adverse effects related to the intervention in adults aged 65 years or older. Electronic database searches will be conducted in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL. A grey literature search will be conducted including clinical trial registries and conference proceedings and abstracts. Two reviewers will independently perform in duplicate citation screening, full-text review, data abstraction, and risk of bias assessment. Conflicts will be resolved through team discussion or by a third reviewer if no consensus can be reached. The Grades of Recommendation, Assessment, Development and Evaluation (GRADE) criteria will be used to independently rate overall confidence in effect estimates for each outcome. Results will be synthesized descriptively, and a random effects meta-analysis will be conducted for each outcome if studies are deemed similar methodologically, clinically, and statistically.
  
  
  
  We will attempt to determine whether a FRID withdrawal strategy alone is effective at preventing falls in older adults. Our results will be used to optimize and focus fall prevention strategies and initiatives internationally with a goal of improving the health of older adults.
  
  
  
  PROSPERO CRD42016040203.
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton Health Sciences, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada. justin.lee@medportal.ca.
authors.forename: Justin Yusen
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Division of Clinical Pharmacology and Toxicology, Department of Medicine, McMaster University, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada.
authors.forename: Anne
authors.initials: A
authors.lastname: Holbrook
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D006801:Humans; D012107:Research Design; D056737:Safety-Based Drug Withdrawals; D000078202:Systematic Reviews as Topic; D015201:Meta-Analysis as Topic
keywords: Deprescribing; Fall-risk increasing drug (FRID); Falls; Falls prevention; Medication withdrawal; Systematic review