Fall-risk-increasing drug use in older community-dwelling adults: prevalence, association with fall-related...

Fall-risk-increasing drugs (FRIDs) may contribute to a higher falls-risk in older people, but research examining standardised screening tools is limited.

To examine FRID prevalence in community-dwelling older adults, any association with subsequent fall-related hospital admissions, and FRID prescriptions before and after admission.

Retrospective cohort study.

Adults aged ≥65 years across 44 general practices in Ireland.

Fourteen FRIDs, defined by Screening Tool of Older Persons Prescriptions in older adults with high Fall risk (STOPPFall) criteria, were examined as time-varying exposures from 2012 to 2016. The association between FRID exposure and fall-related admissions was estimated using Cox proportional hazards models, adjusted for relevant confounders. Participants' FRID use pre- and post-fall-related admission was analysed descriptively.

Of the 35 942 participants, 16 780 (47%) were prescribed at least one long-term FRID at baseline, and 867 (2.4%) experienced a subsequent fall-related admission. Long-term FRID use was associated with a higher risk of fall-related admission [adjusted hazard ratio (aHR) 2.85, 95% CI 2.13-3.82, P < .001], demonstrating a stronger association with an increasing FRID burden-one FRID: aHR 2.81 (95% CI 2.07-3.82, P < .001); ≥5 FRIDs: 5.67 (95% CI 3.70-8.70, P < .001). Long-term FRID prevalence measured pre- and post-fall-related admission was unchanged (53.9%-53.2%). A total of 148 (19.5%) participants had a FRID discontinued, 86 (11.3%) were prescribed an additional FRID and 110 (14.5%) had a FRID initiated for the first time.

FRID use, defined via STOPPFall, was prevalent in older adults and associated with a substantially increased risk of injurious falls. FRID use remained unchanged following discharge. Guidelines recommend including medication review in fall-risk assessments, but further work is needed to embed this across health systems.