Fall-risk-increasing drug use in older community-dwelling adults: prevalence, association with fall-related admissions and post-discharge prescribing changes—a retrospective cohort study
Steven Gilmore, Ann Sinéad Doherty, Frank Moriarty, Fiona Boland, Caroline McCarthy, Ryan Muddiman, Barbara Clyne, Tom Fahey, Denis O’Mahony, Emma WallaceAbstract
Background
Fall-risk-increasing drugs (FRIDs) may contribute to a higher falls-risk in older people, but research examining standardised screening tools is limited.
Objectives
To examine FRID prevalence in community-dwelling older adults, any association with subsequent fall-related hospital admissions, and FRID prescriptions before and after admission.
Design
Retrospective cohort study.
Subjects/setting
Adults aged ≥65 years across 44 general practices in Ireland.
Methods
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.
Findings
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.
Conclusion
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.