Fall-Risk-Increasing drugs and falls in community-dwelling older adults: a prospective cohort study in a single Danish municipality

Purpose Fall-risk-increasing drugs (FRIDs) are a significant and modifiable risk factor for falls in older adults. However, prospective data using robust fall ascertainment on specific FRID classes are scarce in community-dwelling populations. We aimed to investigate the association between individual FRID classes and both single and recurrent falls in older community-dwelling adults. Methods We analysed data from a Danish prospective cohort of 241 community-dwelling adults aged ≥ 75 years. Medication records were collected at baseline, and drugs were classified using the STOPPFall consensus FRIDs list. Falls were recorded prospectively for 1 year using monthly fall-calendars, verified using telephone follow-ups. Associations between FRIDs and one-time (1 fall) and recurrent falls (≥ 2 falls) were explored using Cox proportional hazards model, adjusting for clinical and sociodemographic factors. Results The median (IQR) age was 82 (80, 86) years, 66.4% were women, and 43.6% had a positive fall history. Prevalences of polypharmacy and use of any FRID were 70.5% and 73.9%, respectively. During follow-up, 88 participants (36.5%) fell at least once while 41 participants (17.0%) fell twice or more. The total number of FRIDs was not associated with falls. Baseline use of benzodiazepine-related drugs, strong anticholinergics, and antiepileptics were significantly associated with recurrent falls in the fully adjusted analyses with hazard ratios (95% confidence intervals) of 3.34 (1.28–8.75), 2.48 (1.04–5.89), and 4.78 (1.24–18.35), respectively. Conclusion Several specific FRID classes were significantly associated with recurrent falls in this cohort of well-functioning community-dwelling adults, highlighting the importance of targeted medication review and careful prescribing strategies.