Features of successful medication review and deprescribing interventions for fall prevention in residential aged care facilities: an intervention component analysis of an updated systematic review

Background: 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. 

Methods: 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. 

Results: 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. 

Conclusions: 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.