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Associations of Polypharmacy, Diuretics and Antipsychotics with Injurious Falls: A Population-Based Cohort Study
Tewodros Yosef1,2, Julie A Pasco3,4, Monica C Tembo3
1Deakin Institute for Mental and Physical Health and Clinical Translation (Deakin IMPACT), School of Medicine, Deakin University and Barwon Health, Geelong, 3220, Australia. s222626666@deakin.edu.au.
Drugs & Aging
|July 23, 2026
Summary
Polypharmacy, diuretic, and antipsychotic use significantly increase injurious fall risk in older adults. Diuretics pose the greatest population risk, underscoring the need for medication reviews to enhance safety.
Area of Science:
- Gerontology
- Pharmacology
- Public Health
Background:
- Population aging is associated with increased multimorbidity and polypharmacy.
- Polypharmacy elevates fall risk due to drug interactions and adverse effects on cognition and balance.
- Specific fall-risk-increasing drugs (FRIDs) may present greater hazards than general polypharmacy.
Purpose of the Study:
- To investigate the association between polypharmacy, diuretic use, antipsychotic use, and injurious falls in older adults.
- To quantify the population-level burden of these medication classes on injurious falls.
Main Methods:
- Utilized data from 952 older adults (≥65 years) from the Geelong Osteoporosis Study.
- Linked participant data with the Victorian Emergency Minimum Dataset to identify fall-related emergency presentations.
- Employed competing risk regression to analyze associations, presenting results as adjusted subdistribution hazard ratios (aSHR) and calculating population attributable fractions (PAF).
Main Results:
- Polypharmacy (aSHR=2.62), diuretic use (aSHR=2.98), and antipsychotic use (aSHR=2.23) were significantly associated with increased injurious fall risk.
- Diuretic use accounted for the largest population attributable fraction (23.0%) of injurious falls.
- The incidence rate of injurious falls was 19.3 per 1000 person-years.
Conclusions:
- Polypharmacy, diuretic, and antipsychotic use are linked to a higher risk of injurious falls in older adults.
- Diuretics represent a substantial population-level burden, highlighting the importance of medication review.
- Further interventional studies are recommended to confirm if medication review and deprescribing can reduce injurious falls.
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