Systematic review and meta-analysis on deprescribing psychotropics to reduce falls in older adults

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Journal of the American Medical Directors Association Published May 7, 2026 Medically reviewed May 8, 2026 Study authors: Yin Fengsheng, Tong Dan, Huo Zhiguo, Wu Houdong, Wang Xiangjin, Luo Gan, Wei Tao, Deng Zhen, Zhang Y… PubMed ↗ DOI ↗ By Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

Key Takeaway

Consider deprescribing psychotropics as a targeted strategy for falls in older adults, but note low evidence certainty and setting-specific effects.

This is a systematic review and meta-analysis of 18 studies (11 RCTs and 7 non-randomized studies) examining structured deprescribing or medication-optimization interventions with an explicit psychotropic component for falls in older adults (≥65 years). The analysis included community, inpatient, long-term care, and postdischarge settings, with a primary focus on falls as the outcome.

The authors synthesized findings from long-term community RCTs (n=1425), which showed no significant reduction in the odds of falls (OR 0.91, 95% CI 0.59-1.39). In contrast, high-fidelity interventions demonstrated a significant reduction in falls (OR 0.61, 95% CI 0.41-0.91), while low-fidelity interventions showed no effect. In the inpatient setting (n=5972), there was a significant reduction in falls (OR 0.43, 95% CI 0.19-0.96; P = .03). However, no significant reduction was observed in long-term care or postdischarge transitional care settings.

The authors noted low to very low certainty evidence across the studies and acknowledged gaps, including the lack of reported adverse events and the need for adequately powered trials tailored to specific care settings. Practice relevance is restrained, supporting a potential targeted role for high-fidelity protocols while underscoring the need for further research.

Limitations include the low certainty of evidence and the absence of safety data. The review does not demonstrate clear effects in long-term care or postdischarge transitional care settings, and findings should be interpreted cautiously.

Study Details

Study typeMeta analysis

Sample sizen = 1,425

EvidenceLevel 1

Follow-up780.0 mo

PublishedMay 2026

PMID41791728

View Original Abstract ↓

OBJECTIVES: To evaluate the effect of deprescribing interventions that explicitly targeted psychotropic medications on fall outcomes in older adults across community, inpatient, long-term care, and postdischarge settings. DESIGN: Systematic review and meta-analysis. SETTING AND PARTICIPANTS: Older adults (≥65 years). METHODS: We searched MEDLINE, Embase, Cochrane CENTRAL, Web of Science, and CINAHL from inception to June 2025. We included randomized controlled trials (RCTs) and high-quality nonrandomized studies of interventions (NRSIs) that compared structured deprescribing or medication-optimization interventions with an explicit psychotropic component against usual care in adults aged ≥65 years. Data were pooled using random-effects models (Restricted Maximum Likelihood estimator), and heterogeneity was quantified using the I statistic. Subgroup analyses were performed based on intervention fidelity and clinical setting. RESULTS: A total of 18 studies (11 RCTs and 7 NRSIs) were included. In the primary analysis of long-term community RCTs (n = 1425), psychotropic-targeting deprescribing interventions did not significantly reduce the odds of falls [odds ratio (OR), 0.91; 95% CI, 0.59-1.39]. However, subgroup analysis indicated a significant reduction in falls for high-fidelity interventions (OR, 0.61; 95% CI, 0.41-0.91), whereas low-fidelity interventions showed no effect. In the inpatient setting, a meta-analysis of 5 NRSIs (n = 5972) demonstrated a significant reduction in falls (OR, 0.43; 95% CI, 0.19-0.96; P = .03). No significant reduction in falls was observed in the long-term care or postdischarge transitional care settings. CONCLUSIONS AND IMPLICATIONS: Based on low to very low certainty evidence, psychotropic-targeting deprescribing interventions may reduce falls in inpatient settings and in high-fidelity community programs, whereas effects were not clearly demonstrated in other settings. These findings support its potential role as a targeted strategy and underscore the need for high-fidelity protocols and adequately powered trials tailored to specific care settings.