Medication and falls in elderly outpatients: an epidemiological study from a German Pharmacovigilance Network

The aim of this study was to investigate the relationship between fall risk increasing drugs (FRIDS) and the risk of falls in regard to fall-related chronic diseases. In total, 39 primary care physicians in Germany participated in the EvaMed Pharmacovigilance Network. Antihypertensives, non-steroidal anti-inflammatory drugs, hypnotics and sedatives, antidepressants and psycholeptics were labelled as FRIDS. A fall was defined according to a diagnosis in the chapter Injury or poisoning (S00-T14 in International Statistical Classification of Diseases 10th Revision (ICD-10)). Patients older than or equal to 65 years with at least two doctor's visits were included. FRIDS were prescribed for 1768 patients from a total of 5124 patients included in the analysis. FRIDS and seven chronic diseases were statistically significant associated with a higher risk of experiencing a fall. The risk was highest for patients with a diagnosis abnormalities of gait and mobility, vertigo, visual -impairment and weight loss, and increased by 50-90% with arthritis, diseases of arteries, arterioles and capillaries and heart failure. From patients (N = 425) with at least one diagnosis of fall, 219 patients were prescribed FRIDS. In 100 (45.7%) of cases the diagnoses for fall were made before and in 105 (47.9%) of cases at least a month after the prescription of FRIDS. 14 (6.4%) patients had a prescription of FRIDS and a diagnosis of fall within one month. Perceptual disorders, low walking speed and pain are prominent predictors for falls in the elderly. A prescription of FRIDS selects more vulnerable patients having a higher risk of falls. However, experiencing a fall is mainly due to the disease followed by treatment. Thus, not prescribing FRIDS will avoid only a small number of falls.