6A-06 - Medication Fall Risk Index (MeFRI): Development and Internal Validation of a New Tool for Assessing Falls Risk Based on Medication Profiles in Residential Aged Care

Background: Certain medications increase falls risk, and for older adults in residential aged care (RAC) homes, this adds to their already high risk. No medication-specific falls risk indices exist for this population.

Objectives: To develop and validate the Medication Fall Risk Index (MeFRI) for identifying residents in RAC homes whose medication profiles indicate an elevated risk of falls.

Methods: Study design: A longitudinal cohort study utilising electronic health data collected over eight years (2014–2022). The study data from 5317 permanent residents, comprising 3932 new admissions (split into 70:30 for training and validation sample 1) and 1385 existing residents (serving as validation sample 2).
Settings: 26 RAC homes in Sydney, New South Wales, Australia.
Exposures/predictors/data source: De-identified and linked data containing demographics, health, incident reports and daily medication administration.
Outcome measures: Incidence of falls in the first 6 months of admission.
Statistical analysis: We used multivariate logistic regression to identify medication classes that were independent predictors of falls in the ‘training’ sample. A regression coefficient approach was then applied to develop a point-based scoring system. The model’s performance was evaluated in validation samples 1 and 2 using the Area Under the Receiver Operating Characteristic curve (AUROC) and calibration metrics.

Results: Nearly half of the residents (48.6%, n=2,585) experienced at least one fall during the study period. After adjusting for relevant demographic and health confounders, the model identified nine medication classes predictive of falls. These included antiparkinsonian drugs, antiepileptics, antidepressants, sedatives-hypnotics, antipsychotics, narcotic analgesics, laxatives, systemic corticosteroids, and systemic antibiotics. Antiparkinsonian drugs had the greatest impact, with users having more than twice the likelihood of falling compared to non-users (OR 2.06, 95% CI 1.51-2.81). The model showed moderate to sufficient discrimination, with AUROC values of 0.67 in the training sample, 0.65 in the validation sample 1, and 0.63 in the validation sample 2. The total risk score ranged from 0 to 16, with scores classified into three risk groups: low (0-3), medium (4-6), and high (≥7).

Conclusions: MeFRI is a valid and easy-to-use tool for identifying residents at higher risk of falls based on their medication profiles in RAC homes. It can support medication management reviews and ongoing monitoring of falls risk using medication data. For comprehensive fall prevention, however, MeFRI should be used alongside other tools that assess additional falls risk factors, such as history of falls and mobility issues.