With an increased fall risk may be attributed to the

with an increased fall risk may be attributed to the fact that
the need for fall prevention might have been anticipated in
patients receiving opioids, because the risk of falling with
opioids is well known.
Effects of characteristics
of medication use on fall risk
Number of medications and drug–drug interaction
In geriatric outpatients, polypharmacy rather than number of
comorbidities was associated with fall risk, and the associa-
tion of number of medications with fall risk was stepwise.
Taking five or more drugs was significantly associated with
an increased risk of falls in geriatric outpatients (OR 4.5, 95%
CI 1.7–12.2) after adjusting for potential confounders.
33,34
Outpatients would experience a 14% increase in fall risk with
the addition of each medication beyond a four-medication
regimen (OR 1.14, 95% CI 1.02–1.27; P = 0.027).
35
Mizukami
et al examined the prevalence of falls among community-
dwelling elderly Japanese individuals, and found that taking
at least four daily prescription medications ( P , 0.05) was
significantly associated with falls.
36
Multivariate logistic regression analysis revealed that the
overall OR of falling among patients using ten or more drugs
was 8.42 (95% CI 4.73–15.0) compared with patients who
used 0–1 drug per day.
37
Another study also showed particular
risk for falling (OR 6.1) in patients taking 10 + drugs.
38
Patients who are taking many different types of medications
are high-risk groups, where increased monitoring or tailored
drug regimens is necessary.
In a prospective cohort study of 204 patients (mean
age 80.5 ± 8.3 years) admitted to hospital after a fall, frail
participants (n = 103) had a significantly higher number of
FRIDs on admission compared with robust patients (n = 101)
(frail 3.4 ± 2.2 versus robust 1.6 ± 1.5, P , 0.0001), total number
of medications (9.8 ± 4.3 versus 4.4 ± 3.3, P , 0.0001), and
DDI exposure (35% versus 5%, P = 0.001). The number of
FRIDs and to a lesser extent total medications at discharge

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Chen et al
were significantly associated with recurrent falls (OR 1.7 and
OR 1.2, respectively), but DDIs were not.
39
French et al analyzed 133,872 outpatient benzodiaz-
epine prescriptions and . 1.5 million nonbenzodiazepine
prescriptions. Micromedex
®
software (Truven Health Analyt-
ics, Rocky Hill, CT, USA) was used to identify combinations
of benzodiazepines and other drugs that are likely to result
in “major” interactions; 71.2% (790 of 1,110) of the unique
patients who experienced an injury had used benzodiazepine
in combination with another drug with a major severity
rating defined by Micromedex. Interestingly, the occur-
rence rate of fall incidents was only 4.3% (320 of 7,522)
among patients who were taking benzodiazepines without
concomitant use of precipitant drugs, whereas concomitant
use of benzodiazepines and precipitant drugs increased the
odds of an injury more than twofold.