A Propensity Score Matched Approach to Assess the Associations of Commonly Prescribed Medications with Fall Risk in a Large Harmonized Cohort of Older Ambulatory Persons

L. J. Seppala, B van de Loo, M. Schut, N. M. van Schoor, B. H. Stricker, R. A. Kenny, F. Moriarty, L. C.P.G.M. de Groot, M. Denkinger, D. Rothenbacher, Nathalie van der Velde*, A. Abu-Hanna

*Corresponding author for this work

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Introduction: Several medication classes are considered to present risk factors for falls. However, the evidence is mainly based on observational studies that often lack adequate adjustment for confounders. Therefore, we aimed to assess the associations of medication classes with fall risk by carefully selecting confounders and by applying propensity score matching (PSM). Methods: Data from several European cohorts, harmonized into the ADFICE_IT cohort, was used. Our primary outcome was time until the first fall within 1-year follow-up. The secondary outcome was a fall in the past year. Our exposure variables were commonly prescribed medications. We used 1:1 PSM to match the participants with reported intake of specific medication classes with participants without. We constructed Cox regression models stratified by the pairs matched on the propensity score for our primary outcome and conditional logistic regression models for our secondary outcome. Results: In total, 32.6% of participants fell in the 1-year follow-up and 24.4% reported falling in the past year. ACE inhibitor users (prevalence of use 15.3%) had a lower fall risk during follow-up when matched to non-users, with a hazard ratio (HR) of 0.82 (95% CI 0.68–0.98). Also, statin users (prevalence of use 20.1%) had a lower risk, with an HR of 0.76 (95% CI 0.65–0.90). Other medication classes showed no association with risk of first fall. Also, in our secondary outcome analyses, statin users had a significantly lower risk. Furthermore, β-blocker users had a lower fall risk and proton pump inhibitor use was associated with a higher risk in our secondary outcome analysis. Conclusion: Many commonly prescribed medication classes showed no associations with fall risk in a relatively healthy population of community-dwelling older persons. However, the treatment effects and risks can be heterogeneous between individuals. Therefore, focusing on identification of individuals at risk is warranted to optimize personalized falls prevention.

Original languageEnglish
Pages (from-to)797-805
Number of pages9
JournalDrugs and Aging
Issue number9
Early online date5 Jul 2021
Publication statusPublished - Sept 2021

Bibliographical note

Funding Information:
This work was supported by the Clementine Brigitta Maria Dalderup fund, which is an Amsterdam University fund. The sponsor played no part in the design, execution, analysis and interpretation of data, or writing of the study. The initial B-PROOF study has received funding so far from the Netherlands Organization for Health Research and Development (ZonMw, Grant 6130.0031), The Hague; unrestricted grant from NZO (Dutch Dairy Association), Zoetermeer; Orthica, Almere; Netherlands Consortium Healthy Ageing (NCHA) Leiden/Rotterdam; Ministry of Economic Affairs, Agriculture and Innovation (project KB-15-004-003), The Hague; Wageningen University, Wageningen; VUmc, Amsterdam; Erasmus Medical Center, Rotterdam. The Longitudinal Aging Study Amsterdam (LASA) is largely supported by a grant from the Netherlands Ministry of Health, Welfare and Sports, Directorate of Long-Term Care. The data collection in 2012–2013 was financially supported by the Netherlands Organization for Scientific Research (NWO) in the framework of the project “New Cohorts of young old in the 21st century” (File Number 480-10-014). The TILDA study is co-funded by the Government of Ireland through the Office of the Minister for Health and Children, by Atlantic Philanthropies and by Irish Life; data were collected under the Statistics Act, 1993, of the Central Statistics Office. The Rotterdam Study is supported by the Erasmus MC University Medical Center and Erasmus University Rotterdam; The Netherlands Organisation for Scientific Research (NWO); The Netherlands Organisation for Health Research and Development (ZonMw); the Research Institute for Diseases in the Elderly (RIDE); The Netherlands Genomics Initiative (NGI); the Ministry of Education, Culture and Science; the Ministry of Health, Welfare and Sports; the European Commission (DG XII); and the Municipality of Rotterdam. The ActiFE-Indicators for Monitoring COPD [Chronic Obstructive Pulmonary Disease] and Asthma–(Activity and Function in the Elderly in Ulm) study was supported by the European Union (No. 2005121), and the Ministry of Science, Baden‐Württemberg, and the German Research Foundation (RO2606/14-1, DE2674/1-1).

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