Nonselective beta-blocker eye drops and the risk of fall-related injuries: a Danish nationwide new user, active...

Falls in older adults are a major health concern. Risk factors include medications, but uncertainty remains about potential fall risk-increasing drugs (FRIDs). This nationwide cohort study examined whether non-selective beta-blocker eye drops (timolol) increase the risk of fall-related injuries compared to topical prostaglandin analogue (TPA) eye drops.

Using registry data from all Danish residents, we included individuals aged ≥65 years who initiated timolol (n = 52 019) or TPA (n = 72 885) between 1996 and 2023. Propensity score matching was applied to balance baseline characteristics. The primary outcome covered hospital-treated fall-related injuries while the secondary outcome was fall-related fractures specifically.

No statistically significant differences were observed in the risk of fall-related injuries or fall-related fractures for timolol vs. TPA users at 14, 90 or 365 days of follow-up, before or after propensity score matching. Predefined subgroup analyses showed an increased risk of fall-related injuries among individuals aged ≥80 years [incidence rate ratio (IRR) 1.23, 95% CI 1.01-1.50] and among users of ≥3 FRIDs (IRR 1.20, 95% CI 1.01-1.44).

Our findings suggest that timolol eye drops are not associated with a significantly increased risk of fall-related injuries in the overall population of older adults. However, a marginally significant increased risk of fall-related injuries was seen among the oldest individuals and those concurrently using multiple FRIDs. These findings underscore the importance of considering a patient-centred approach when prescribing medications that could be potentially harmful.