Different risk-increasing drugs in recurrent versus single fallers: are recurrent fallers a distinct population?

backgroundPolypharmacy, and specifically the use of multiple fall-risk-increasing drugs (FRID), have been associated with increased risk of falling in older age. However, it is not yet clear whether the known set of FRIDs can be extrapolated to recurrent fallers, since they form a distinct group of more vulnerable older persons with different characteristics.

objectivesWe aim to investigate which classes of medications are associated with recurrent falls in elderly patients visiting the Emergency Department (ED) after a fall.

methodsThis study had a cross-sectional design and was conducted in the ED of an academic medical center. Patients who sustained a fall, 65 years or older, and who visited the ED between 2004 and 2010 were invited to fill in a validated fall questionnaire designed to assess patient and fall characteristics (CAREFALL Triage Instrument [CTI]). We translated self-reported medications to anatomical therapeutic chemical (ATC) codes (at the second level). Univariate logistic regression analysis was performed to explore the association between medication classes and the outcome parameter (recurrent fall). Multivariate logistic regression was used to assess the associations after adjustment to potential confounders.

resultsIn total 2,258 patients participated in our study, of whom 39 % (873) had sustained two or more falls within the previous year. After adjustment for the potential confounders, drugs for acid-related disorders (adjusted odds ratio [aOR] 1.29; 95 % CI 1.03–1.60), analgesics (aOR 1.22; 95 % CI 1.06–1.41), anti-Parkinson drugs (aOR 1.59; 95 % CI 1.02–2.46), nasal preparations (aOR 1.49; 95 % CI 1.07–2.08), ophthalmologicals (aOR 1.51; 95 % CI 1.10–2.09); antipsychotics (aOR 2.21; 95 % CI 1.08–4.52), and antidepressants (aOR 1.64; 95 % CI 1.13–2.37) remained statistically significantly associated with an ED visit due to a recurrent fall.

conclusionsKnown FRIDs, such as psychotropic drugs, also increase the risk of recurrent falls. However, we found four relatively new classes that showed significant association with recurrent falls. In part, these classes may act as markers of frailty and comorbidity, or they may reflect differences in the risk factors affecting the older, frailer population that tends to sustain recurrent falls. Further investigation is needed to elucidate causes and ways to prevent recurrent falls.