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

Abstract Background 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 and fractures among a large cohort of community-dwelling people ≥65 years using The Irish Longitudinal Study on Ageing (TILDA) Waves 1–6, collected from 2009–2021. Methods STOPPFall medications were recorded at Wave 1 and Wave 3. Falls and fractures were self-reported. Logistic regression models reporting odds ratios (ORs) assessed the association between STOPPFall medications and falls (including injurious and unexplained falls) and fractures at follow-up, adjusted for relevant covariates including age, sex, educational attainment, heart disease, pain, depression, anxiety, sleep disorder, indication for antipsychotic medication, urinary incontinence, alcohol excess, osteoporosis status by heel ultrasound, chronic disease burden, cognitive impairment, previous fracture and follow up duration. Results Over one in four participants (777/2898, 27%) were prescribed one STOPPFall medication, and a further 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.