Fall-Risk-Increasing Drugs: Background, Current Evidence on Deprescribing, and Future Perspectives

Key Messages

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  The use of fall-risk-increasing drugs (FRIDs) is one of the most prominent fall risk factors

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  Deprescribing FRIDs is an essential component of the multifactorial intervention to prevent falls and injurious falls

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  EuGMS Task and Finish Group on FRIDs was established to tackle the lack of knowledge on FRIDs and develop deprescribing aids for both healthcare professionals and older adults at risk for falls

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  STOPPFall, a European consensus deprescribing tool, was created by the EuGMS Task and Finish Group to provide a first step towards harmonizing practice and guidelines on drug-related falls internationally

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  To further optimize prevention of medication-related falls, the following is warranted:

  • 1)

    greater awareness and knowledge of all stakeholders

  • 2)

    development of effective and personalized deprescribing aids

  • 3)

    development of effective implementation strategies for FRIDs deprescribing, that take the patient perspective into account

  • 4)

    promote high-quality research and innovative research techniques, such as modern data-driven methods, considering the complexity of deprescribing interventions and heterogeneity of older persons

General Background: Falls And Falls Prevention

As the world ages, falls are a growing public health concern with a substantial impact on individuals as well as the society. Approximately one out of three of adults aged 65 years and older fall at least once a year, and over 60% percent of those who fell in the past year report being injured (Ganz & Latham, 2020; Milat et al., 2011). Of all fall incidents, around 10-15% lead to a fracture and 5% serious soft tissue injury or head trauma (Berry & Miller, 2008). Falls are even more common in older and institutionalized populations; approximately one out of two institutionalized persons and persons aged 80 years and older will experience one or more falls yearly (Berry & Miller, 2008). Furthermore, fall incidents have been associated with many negative health effects in older persons, including greater functional decline, social withdrawal, symptoms of anxiety and depression, and fear of falling (Berry & Miller, 2008). Also, due to all adverse health-related effects, fall incidents have a drastic impact on healthcare expenditure. In Western countries, approximately 0.85-1.5% of the total healthcare expenditure are fall-related costs (Heinrich et al., 2010). Predominantly falls result from interacting risks, and certain medication classes are a significant risk factor for falls (de Vries et al., 2018; Seppala, van de Glind, & Daams, 2018; Seppala, Wermelink, & de Vries, 2018).