Drugs & Aging

, Volume 31, Issue 12, pp 917–927 | Cite as

Medication-Related Fall Incidents in an Older, Ambulant Population: The B-PROOF Study

  • Annelies C. Ham
  • Karin M. A. Swart
  • Anke W. Enneman
  • Suzanne C. van Dijk
  • Sadaf Oliai Araghi
  • Janneke P. van Wijngaarden
  • Nikita L. van der Zwaluw
  • Elske M. Brouwer-Brolsma
  • Rosalie A. M. Dhonukshe-Rutten
  • Natasja M. van Schoor
  • Tischa J. M. van der Cammen
  • Paul Lips
  • Lisette C. P. G. M. de Groot
  • André G. Uitterlinden
  • Renger F. Witkamp
  • Bruno H. Stricker
  • Nathalie van der VeldeEmail author
Original Research Article



Medication use is a potentially modifiable risk factor for falling; psychotropic and cardiovascular drugs have been indicated as main drug groups that increase fall risk. However, evidence is mainly based on studies that recorded falls retrospectively and/or did not determine medication use at the time of the fall. Therefore, we investigated the associations indicated in the literature between medication use and falls, using prospectively recorded falls and medication use determined at the time of the fall.


Data from the B-PROOF (B-vitamins for the prevention of osteoporotic fractures) study were used, concerning community-dwelling elderly aged ≥65 years. We included 2,407 participants with pharmacy dispensing records. During the 2- to 3-year follow-up, participants recorded falls using a fall calendar. Cox proportional hazard models were applied, adjusting for potential confounders including age, sex, health status variables and concomitant medication use.


During follow-up, 1,147 participants experienced at least one fall. Users of anti-arrhythmic medication had an increased fall risk (hazard ratio [HR] 1.61; 95 % confidence interval [CI] 1.12–2.32) compared with non-users. Similarly, non-selective beta-blocker use was associated with an increased fall risk (HR 1.41 [95 % CI 1.12–1.78]), while statin use was associated with a lower risk (HR 0.81 [95 % CI 0.71–0.94]). Benzodiazepine use (HR 1.32 [95 % CI 1.02–1.71]), and antidepressant use (HR 1.40 [95 % CI 1.07–1.82]) were associated with an increased fall risk. Use of other cardiovascular and psychotropic medication was not associated with fall risk.


Our results strengthen the evidence for an increased fall risk in community-dwelling elderly during the use of anti-arrhythmics, non-selective beta-blockers, benzodiazepines, and antidepressant medication. Clinicians should prescribe these drugs cautiously and if possible choose safer alternatives for older patients.


Timolol Medication Group Fall Risk Handgrip Strength Fall Incident 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors gratefully thank all study participants and all dedicated co-workers who helped in the success of the B-PROOF trial, especially S. Smits, R.N.; P.H. in ‘t Veld, MSc; M. Hillen-Tijdink; A. Nicolaas-Merkus; and N. Pliester. In addition, we thank SFK for their cooperation and for providing the pharmacy dispensing records, especially J. Lukaart, MSc.

B-PROOF is supported and funded by The Netherlands Organization for Health Research and Development (ZonMw, Grant 6130.0031 and 11-31010-06), the Hague; unrestricted grant from NZO (Dutch Dairy Association), Zoetermeer; NCHA (Netherlands Consortium for Healthy Ageing) Leiden/ Rotterdam; Ministry of Economic Affairs, Agriculture and Innovation (project KB-15-004-003), the Hague; Wageningen University, Wageningen; VU University Medical Centre, Amsterdam; Erasmus Medical Center, Rotterdam. All organisations are based in the Netherlands. The sponsors do not have any role in the design or implementation of the study, data collection, data management, data analysis, data interpretation, or in the preparation, review, or approval of the manuscript.

The authors have no potential conflicts of interest that are directly relevant to the content of this study.

Supplementary material

40266_2014_225_MOESM1_ESM.docx (41 kb)
Supplementary material 1 (DOCX 40 kb)


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Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Annelies C. Ham
    • 1
  • Karin M. A. Swart
    • 2
  • Anke W. Enneman
    • 1
  • Suzanne C. van Dijk
    • 1
  • Sadaf Oliai Araghi
    • 1
  • Janneke P. van Wijngaarden
    • 3
  • Nikita L. van der Zwaluw
    • 3
  • Elske M. Brouwer-Brolsma
    • 3
  • Rosalie A. M. Dhonukshe-Rutten
    • 3
  • Natasja M. van Schoor
    • 2
  • Tischa J. M. van der Cammen
    • 1
  • Paul Lips
    • 2
    • 4
  • Lisette C. P. G. M. de Groot
    • 3
  • André G. Uitterlinden
    • 1
    • 5
  • Renger F. Witkamp
    • 3
  • Bruno H. Stricker
    • 1
    • 5
  • Nathalie van der Velde
    • 1
    • 6
    Email author
  1. 1.Section of Geriatrics, Department of Internal MedicineErasmus MC, University Medical Centre RotterdamRotterdamThe Netherlands
  2. 2.Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care ResearchVU University Medical CentreAmsterdamThe Netherlands
  3. 3.Division of Human NutritionWageningen UniversityWageningenThe Netherlands
  4. 4.Department of EndocrinologyVU University Medical CentreAmsterdamThe Netherlands
  5. 5.Department of EpidemiologyErasmus MC, University Medical Centre RotterdamRotterdamThe Netherlands
  6. 6.Section of Geriatric Medicine, Department of Internal MedicineAcademic Medical CentreAmsterdamThe Netherlands

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