Polypharmacy as a Simple Measure for Assessing the Risk of Fall-Related Hospitalization in Older Adults

Medication is a modifiable risk factor for falls. Evaluating medication use may aid in identifying individuals at increased risk of a first fall and in preventing associated outcomes. The aim of this study was to identify the best medication-based measure to evaluate fall-related hospitalization risk among older adults.

A population-based cohort was created using the Quebec Integrated Chronic Disease Surveillance System. Individuals aged >66 on April 1, 2019 (index date) insured by the public drug plan and without fall-related hospitalization the prior year were included. Five medication-based measures were developed, derived from the average number of medications claimed in the previous year (≥5, ≥10 medications, ≥5 third-level Anatomical Therapeutic Chemical classes, ≥1 fall-risk increasing drugs, ≥1 potentially inappropriate medications). Hazard ratios were estimated with sex-stratified Cox models to predict fall-related hospitalization in the year after index date. Predictive performances were compared between each medication-based measure.

The cohort included 647,795 women and 529,725 men. Hazard ratios ranged from 1.43 (95% CI=1.37, 1.49) for ≥1 potentially inappropriate medication (women) to 2.17 (95% CI=2.05, 2.31) for ≥10 medications (men). Lowest predictive performance was for ≥1 potentially inappropriate medication (c-statistic=0.724 [women]; 0.722 [men]), and highest predictive performance was for ≥1 fall-risk increasing drug (c-statistic=0.735 [women], 0.736 [men]).

All medication-based measures have similar performance in assessing fall-related hospitalization. From a public health standpoint, measures that have the added benefits of being simple and accessible, such as polypharmacy, can support surveillance efforts and inform public health actions.