How do falls-risk increasing drugs modify the association between index falls and future falls and fracture burden? Secondary data analysis from the Irish longitudinal study on ageing

Abstract Background Falls are a major tipping point in older adults, heralding functional decline and increased healthcare utilisation. Falls-risk–increasing drugs (FRIDs) are a key risk factor for falls, but their influence on outcomes when prescribed after a fall is under-examined. This study examined the association between an index fall requiring medical attention and subsequent 2-year risk of falls and fractures, evaluating how FRID use modifies this relationship. Methods We analysed data from Waves 5 and 6 of The Irish Longitudinal Study on Ageing, including participants ≥ 70 years with 2-year follow-up. FRIDs were identified from medication lists using STOPPFall. Regression models were used to assess the association between index falls and falls/fracture outcomes during follow-up: Falls, falls requiring medical attention, emergency department visits due to falls, and fractures. Two-way interactions were used to assess how FRID use modified this association. Results Of 1717 participants, 14% reported a fall requiring medical attention at baseline; 38% were prescribed ≥ 1 FRID. Index falls were associated with increased future falls (OR 2.65), falls requiring medical attention (OR 3.82), ED attendance due to a fall (OR 2.93), and fractures (OR 2.46) over 2 years (all p < 0.01). Combined exposure to both a fall and FRIDs further amplified risk, with odds ratios ranging from 3.77 to 4.36 across outcomes. Conclusion A fall requiring medical attention is a strong predictor of future falls burden, and FRID use significantly amplifies this risk. These findings highlight the need for targeted medication review within comprehensive geriatric assessment for older people with falls.