Impact of Discontinuation of Fall-Risk-Increasing Drugs on Falls in Multimorbid Older Patients With Polypharmacy

Abstract

Background: Falls are a major concern in the older population. An important cause of falls is fall-risk-increasing drugs (FRID). However, it is not known if the discontinuation of FRID leads to a reduction of falls. Therefore, the aim of this study was to assess the association between discontinuation of FRID and the occurrence of falls and recurrent falls.

Methods: This study included adults aged ≥ 70 years with multimorbidity and polypharmacy who were enrolled in a cluster randomized controlled trial assessing hospital pharmacotherapy optimization (OPERAM). Participants who were using FRID at baseline, were alive after 2 months of follow-up, and provided data on fall occurrence were included. FRID discontinuation was defined as discontinuation of ≥ 1 FRID within 2 months after inclusion, including the following groups: antidepressants, antiepileptics, antihistamines, antipsychotics, benzodiazepines and z-drugs, diuretics, opioids, and alpha-blockers. Multivariable cox regression analysis, using inverse probability weighting, was performed to assess the association between FRID discontinuation and the occurrence of falls.

Results: Our analysis included 1546 participants, with a median age of 79 years (IQR 74-84) and 45% female. After 2 months of follow-up, FRID were discontinued in 878 (57%) participants. Among all participants, 378 (24%) experienced a fall within 1 year of follow-up, with 137 (9%) of the participants experiencing two or more falls, and 199 (13%) participants experiencing a serious fall. No association was found between FRID discontinuation and the occurrence of falls. In a subgroup of participants with a previous fall, discontinuation of antipsychotics was associated with a lower occurrence of falls (HR 0.32 [CI 0.12-0.84], p = 0.02).

Conclusions: In multimorbid older patients using FRID, falls are highly prevalent. No association was found between discontinuation of FRID and the risk of falls, except for the discontinuation of antipsychotics in patients who experienced a previous fall.

Keywords: FRID; accidental falls; deprescribing; fall interventions.

FIGURE 1

Number of patients using FRID at baseline, and after 2 months. ABC; alpha‐blockers prescribed for hypertension, ABP; alpha‐blockers prescribed for benign prostatic hyperplasia, AD; antidepressants, AEP; antiepileptics, AH; antihistamines, AP; antipsychotics, BZRA; benzodiazepine receptor agonists, INC; medication used for overactive bladder and incontinence, VD; vasodilators.