Psychotropic medication withdrawal and a home-based exercise program to prevent falls: a randomized, controlled trial

Area of Science:

• Gerontology
• Pharmacology
• Preventive Medicine

Background:

• Falls are a major health concern for older adults.
• Psychotropic medications are commonly prescribed to older individuals.
• Medication withdrawal and exercise are potential strategies to mitigate fall risk.

Purpose of the Study:

• To evaluate the efficacy of psychotropic medication withdrawal in reducing falls among the elderly.
• To determine the impact of a home-based exercise program on fall prevention in older adults.
• To assess the combined effects of medication withdrawal and exercise using a factorial design.

Main Methods:

• A randomized controlled trial with a 2x2 factorial design was conducted.
• Participants (n=93) aged 65+ years, taking psychotropic medication, were recruited from general practices in Dunedin, New Zealand.
• Interventions included gradual psychotropic medication withdrawal versus continuation, and a home-based exercise program versus no exercise, with 44 weeks of follow-up.

Main Results:

• Psychotropic medication withdrawal demonstrated a significant reduction in the relative hazard for falls (Hazard Ratio = 0.34, 95% CI: 0.16-0.74).
• The home-based exercise program did not yield a statistically significant reduction in the risk of falling.
• Intent-to-treat analysis was employed to assess outcomes.

Conclusions:

• Gradual withdrawal of psychotropic medication is an effective strategy for reducing falls in older people.
• Permanent cessation of psychotropic medication presented difficulties in practice.
• The home-based exercise intervention, as implemented, did not significantly impact fall rates.