Fall-risk-increasing drugs and falls prevention Towards a personalized approach for medication management

Falls are a major public health concern in our ageing societies. One of the modifiable risk factors for falls is certain medication use (Fall-risk-increasing Drugs, FRIDs). However, there is no consensus on which medications should be considered as FRIDs. Therefore, the first aim of this thesis was to investigate the associations between medication use and falls. To this aim, we performed several systematic reviews (Chapters 2, 3 and 4). In addition, we created an international consensus list of FRIDs using a Delphi process (Chapter 10). It contains mainly psychotropic medications, but also several other pharmacological classes.
Furthermore, to enable efficient implementation of falls preventive strategies, it is necessary to identify high-risk individuals at first. Thus, the second aim of this thesis was to gain further insights regarding who is at risk for falls and medication-related falls. To this aim, we developed prediction models for fall occurrence and recurrent falling (Chapter 6). In addition, we linked a small proportion of the fall risk to genetics in a genome-wide association study (Chapter 7) and studied whether candidate polymorphisms are associated with fall risk in antidepressant users (Chapter 8).
In the last part of this thesis we focused on deprescribing of FRIDs. First, we investigated the effectiveness of medication review and deprescribing interventions in falls prevention by applying meta-analyses using data from published literature (Chapter 9). Finally, as medication management in older fallers is highly complex, we created a structured FRIDs deprescribing tool to aid physicians in their daily decision-making process (Chapter 10).