The combined association of STOPPFall medication use and orthostatic blood pressure abnormalities with future falls and fractures in community-dwelling older people

PURPOSE: STOPPFall(Screening Tool of Older Persons Prescriptions in older adults with high fall risk) defines fall-risk-increasing drugs(FRIDs) associated with orthostatic hypotension(OH)/falls. This study assesses the association between the cumulative effect of STOPPFall medications and OH, on future falls/fractures, over 4-year follow-up among community-dwelling older people ≥ 65 years using The Irish Longitudinal Study on Ageing(TILDA) data. METHODS: STOPPFall medications were recorded at Wave1. Orthostatic blood pressure(BP) was measured by active stand using a Finometer at Wave1, recording delayed BP recovery(drop in systolicBP(sBP) ≥ 20 mmHg and/or diastolicBP ≥ 10 mmHg from baseline at 30 s post-stand) and "any OH"(same BP drop at any of 30,60,90,120 s post-stand). Falls/fractures were self-reported. Logistic regression models using interaction terms generated odds ratios(ORs) assessing the association between the interaction of STOPPFall medications and delayed BP recovery/any OH at baseline, and falls(including injurious/unexplained falls) and all fractures at follow-up. RESULTS: 1390 participants were included, mean age at baseline 71.0 years, 51% female. One STOPPFall medication was prescribed in 27%(372/1390) participants, 11%(147/1390) were prescribed ≥ 2STOPPFall medications. Over 40% participants fell during follow-up(592/1390,42.6%), 12%(160/1390) sustained fractures. The cumulative effect of ≥ 2STOPPFall medications and delayed BP recovery was independently associated with all falls[OR1.93(95%CI1.04-3.59);p = 0.036], injurious falls[OR2.97(95%CI1.55-5.68);p = 0.001] and all fractures[OR3.50(95%CI1.66-7.41);p = 0.001]. Prescription of ≥ 2STOPPFall medications and any OH was independently associated with all falls[OR1.98(95%CI1.11-3.54);p = 0.021], injurious falls[OR2.25(95%CI1.21-4.20);p = 0.011] and all fractures[OR2.81(95%CI1.34-5.90);p = 0.006]. CONCLUSION: Prescription of ≥ 2 STOPPFall medications and delayed BP recovery, and prescription of ≥ 2 STOPPFall medications and any OH, was associated with all falls, injurious falls and all fractures. This highlights the importance of multidomain interventions during multifactorial falls assessments.