- Design
- Retrospective population-based cohort
- Population
- 120,867 adults ≥65 prescribed at least one fall-risk-increasing drug, Germany
- Primary outcome
- Fall-related hospitalisation in 2019
- Effect
- 2.3% admitted; higher risk with SSRIs, older antiepileptics, moderate anticholinergics; model AUC 0.73
A German population-based cohort followed 120,867 adults aged 65 and over prescribed at least one fall-risk-increasing drug; 2788 (2.3%) were admitted with a fall-related injury during 2019.
Within this already-exposed group, serotonin reuptake inhibitors, older antiepileptics and drugs with moderate anticholinergic activity marked higher risk after adjustment for general predictors. A broader framework of drugs with fall-related adverse reactions added little. The model discriminated moderately (AUC 0.73) and was stable on internal validation.
Most older adults take at least one fall-risk drug, so reviewing all of them in everyone is impractical. This gives a starting order: the drug classes that separate higher-risk patients from the rest.
- Flag patients on SSRIs or SNRIs, older antiepileptics (carbamazepine, phenytoin, valproate) or anticholinergics.
- Review indication and dose for these first.
- Consider safer alternatives where available.
- Combine with a falls assessment: gait, vision, footwear, home hazards.
Why it matters
It turns a long, uniform list of fall-risk drugs into a priority order.
Don't overread it
Observational and not externally validated; it identifies higher-risk patients, not proof that stopping the drugs prevents falls.
The statistics, in plain English
An AUC of 0.73 means the model separates people who will and will not be admitted after a fall moderately well. The drug associations are adjusted but still observational — depression or epilepsy themselves may raise fall risk.
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