OBJECTIVES: Certain medications can increase fall risk, resulting in injuries and functional decline. Fall-risk-inducing drugs (FRIDs) are used commonly by older cancer survivors. We examined prevalence and effects of FRIDs on fall risk in older adults with cancer.

METHODS: Using the Surveillance Epidemiology and End Results and Medicare Health Outcomes Survey (SEER-MHOS) data resource and linked Medicare Part D (prescription drug) claims from 2008-2015, we characterized FRID prescribing patterns in the 12 months prior to survey, focusing on the maximum number of concurrent FRIDs prescribed in any given month. We characterized FRID class patterns and individual FRID medication counts. Falls and additional covariates were captured from the survey. Multivariable logistic regression was used to estimate associations between falls in cancer survivors and maximum concurrent FRIDs, adjusting for clinical and sociodemographic factors.

RESULTS: Participants included individuals with (n=11,581) and without (n=12,906) cancer. Proportions reporting a fall in the past 12 months were comparable in those with (22%) and without cancer (23%) (p=0.43). Approximately 76% of those with cancer, and 69% of those without received ≥2 concurrent FRIDs; mean (range) number of concurrent FRID prescriptions were 3.1 (0-18) and 2.8 (0-15) per month, respectively (all p<0.001). Approximately 51% of cancer survivors had 1+ prescription for an opioid, central analgesic, or opioid receptor agonist, compared to 32% of individuals without cancer (p<0.001). FRID polypharmacy and problems with balance and walking were independent predictors of falling, after adjusting for sociodemographic factors, comorbidities, cancer stage, and years since cancer diagnosis. Every additional concurrent FRID increased the odds of a fall by 12% (95% CI 1.09-1.15).

CONCLUSIONS: These observations indicate that clinical interventions such as medication reconciliation and FRID deprescribing, together with surveillance for and mitigation of problems with balance and walking, are essential components of mitigating fall risk in older adult cancer survivors.