Fall Risk–Increasing Drugs and Fall-Related Injuries among Older Adults in Ontario: A Population-Based Matched Case-Control Study

OBJECTIVES: Commonly prescribed medications individually increase the risk of falls. Less is known about the association between multiple fall risk-increasing drug (FRID) use and falls. We examined the association between 12 major FRID classes, alone and in combination and fall-related injuries among older adults in home care (HC) and long-term care (LTC) settings. DESIGN: Matched, case-control study. SETTING AND PARTICIPANTS: HC recipients and LTC residents in Ontario, Canada, from 2008 to 2016. METHODS: Cases were matched to controls by sex, age, history of falls, calendar year, and disease risk score. Using multivariable logistic regression, the associations between FRID exposure in the 90 days preceding falls and fall-related injuries that required emergency department or hospitalization were determined with adjusted odds ratios (aORs) and 95% confidence intervals (CIs). RESULTS: Exposure to any FRID increased the risk of fall-related injury when compared with non-users in both HC (aOR, 1.34; 95% CI, 1.30-1.40) and LTC (aOR, 1.54; 95% CI, 1.46-1.63) populations. The increased odds of fall-related injuries were evident among most FRID categories, with the highest odds found with dopaminergic agents and antidepressants in both HC and LTC populations. The use of multiple FRIDs was associated with a greater odds of fall-related injury. Exposure to ≥5 FRIDs was associated with an almost twofold higher odds of fall-related injury in HC (aOR, 1.67; 95% CI, 1.57-1.77) and LTC (aOR, 1.92; 95% CI, 1.73-2.13) residents compared with non-users. The findings were similar across multiple subgroups and sensitivity analyses, with higher odds among new users compared with chronic users. CONCLUSIONS AND IMPLICATIONS: Multiple categories of FRIDs are associated with an increased risk of fall-related injuries in older adults. Clinicians should minimize use of these medications wherever possible. Fall prevention initiatives should incorporate strategies to prioritize deprescription of the highest risk FRIDs.