The weight of pills: medication use and fall incidence in Saudi community-dwelling adults aged 50 years and older: a 10-month longitudinal study

Abstract

Despite the growing body of global evidence on the use of medications associated with a risk of falls, there is a lack of research on medications and future fall incidence in the Saudi population. This study aimed to explore the association of the baseline number of medications and polypharmacy with fall incidence at 4–6 and 9-10 months of follow-up among Saudi adults aged 50 years and older. A prospective longitudinal study was conducted among 211 Saudi adults aged 50 years and older. Participants were recruited from community settings including hospitals, clinics, malls, and mosques. Data were collected at three assessment time points: baseline (February–April 2022), 4–6 months (August-September 2022), and 9–10 months (November 2022–January 2023). The number of medications and polypharmacy (≥4 medications) were verified during participant interviews at baseline. Fall events (fall vs. no fall) were documented at three time points across 10 months of follow-up, including baseline fall history, fall incidence at 4–6 months, and fall incidence at 9-10 months of follow-up. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Baseline polypharmacy was significantly associated with an approximately fourfold increase in fall incidence (HR: 3.99, 95% CI: 1.63–9.81; p  = 0.003) in the final parsimonious model retaining age and the Insomnia Severity Index (ISI) score. The number of medications was not significantly associated with fall incidence in the final adjusted model. This exploratory study suggests a possible association between baseline polypharmacy and fall incidence over a follow-up period of up to 10 months among community-dwelling Saudi adults aged 50 years and older. However, these findings were based on a small polypharmacy subgroup ( n  = 14) and include only six events, so they should be interpreted with caution. These findings may support further investigation of medication and polypharmacy screening as part of broader fall-risk management strategies for community-dwelling older adults. However, further research is needed to confirm this association and clarify its clinical implications.