PolyPIMuse significantly increases fall risk: comparison of three medication evaluation tools

Introduction Falls are a leading cause of injury and hospitalization in older adults, with pharmacotherapy identified as a modifiable risk factor. Tools for identifying potentially inappropriate medications (PIMs), such as the EU(7)PIM, PRISCUS, and FORTA lists, differ in methodology. However, their comparative performance in predicting fall risk has not been systematically evaluated. The aim of our work was to investigate the association between PIM use and fall risk among older adults and to analyze the correlations between PIM utilization based on three PIM lists (EU(7)PIM, PRISCUS, and FORTA C/D) and fall risk. Methods In a retrospective case -control study based on real-world data from Hungarian emergency and primary care settings, we analyzed fall-related emergency department visits (n=886) in individuals aged ≥65 years and matched them with a control group from general practices (n = 1364). Results Use of PIMs identified by all three lists was significantly associated with increased fall risk. (Use of 1 FORTA C/D active substance: AOR: 1.434; CI95%:1.120–1.838; p = 0.004; Use of 1 EU(7)PIM active substance: AOR: 1.201; CI95%: 0.907–1.591; p = 0.200; Use of 1 PRISCUS active substance: AOR: 1.390; CI95%:1.069–1.808; p = 0.014) Of the three lists, use of drugs on the PRISCUS list was most significantly associated with increased fall risk. (Use of 2 PRISCUS active substance: AOR: 1.557; CI95%:1.148–2.114; p = 0.004; Use of 3 PRISCUS active substance: AOR: 2.045; CI95%: 1.408–2.982; p = 0.000; Use of 4 PRISCUS active substance: AOR: 1.869; CI95%: 1.149–3.065; p = 0.012; Use of 5 PRISCUS active substance: AOR: 2.638; CI95%: 1.464–4.895; p = 0.002). Discussion We introduce the concept of “polyPIMuse” –the use of ≥5 PIM-listed drugs –which further elevated fall risk, particularly for PRISCUS and FORTA C/D lists. Despite methodological differences, all three PIM tools proved useful in predicting fall risk. Incorporating these tools into routine medication reviews may aid fall prevention strategies in geriatric care.