The association between STOPPFall medication use and falls and fractures in community-dwelling older people

Abstract

Introduction: Falls and fractures are common among older people. The Screening Tool of Older Persons Prescriptions in older adults with high fall risk (STOPPFall) provides a comprehensive list of fall-risk-increasing drugs (FRIDs). This study assesses the association between STOPPFall medications and future falls/fractures among a large cohort of community-dwelling people ≥65 years using The Irish Longitudinal Study on Ageing (TILDA) Waves 1-6, collected from 2009 to 2021.

Methods: STOPPFall medications were recorded at Wave 1 and Wave 3. Falls/fractures were self-reported. Logistic regression models reporting odds ratios (ORs) assessed the association between STOPPFall medications and falls (including injurious/unexplained falls) and fractures at follow-up, adjusted for relevant covariates.

Results: Over one in four participants (777/2898, 27%) were prescribed one STOPPFall medication, and 15% (421/2898) were prescribed ≥2 STOPPFall medications. Over half of participants fell during follow-up, with 1/5 sustaining any fracture. Prescription of ≥2 STOPPFall medications was independently associated with all falls [OR 1.67 (95%CI 1.28-2.18); P < 0.001], injurious falls [OR 1.53 (95%CI 1.19-1.97); P = 0.001], unexplained falls [OR 1.86 (95%CI 1.43-2.42); P < 0.001], all fractures [OR 1.59 (95%CI 1.20-2.12); P = 0.001] and hip fractures [OR 1.75 (95%CI 1.00-3.05); P = 0.048]. Increasing prescription of ≥2 STOPPFall medications at Wave 3 was associated with increased likelihood of all falls and injurious falls.

Conclusion: Prescription of ≥2 STOPPFall medications is independently associated with an increased likelihood of all falls and all fractures. This is a potentially modifiable risk factor for falls, and an increased falls risk should be considered when prescribing these medications.

Keywords: deprescribing; fall-risk-increasing drugs; hip fracture; older people; unexplained falls.