Several tools and drug lists are available to support medication optimisation in falls. The STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk) can be used to identify FRIDs and support deprescribing.¹⁴

For each drug class in the deprescribing tool, the entry describes factors indicating the withdrawal of the drug would be beneficial. It also describes whether a withdrawal should be stepwise and what should be monitored after deprescribing, such as the return of symptoms (see box).^5,14

The National Falls Prevention Coordination Group endorsed by the Royal Pharmaceutical Society, published ‘Medicines and Falls’ guidance in 2023. In medicines reviews for people at risk of falls it is important to check the patient’s medical history to establish why each medicine was prescribed, when it was started, whether it is effective and whether it is causing side effects. The review should also attempt to reduce medicines numbers and doses, while checking appropriateness and whether side effects are a concern.⁹

The NFPCG/RPS guidance lists more than 125 FRIDs and gives another list of medicines which can increase fracture risk. Medicines categories and specific drugs associated with increased falls risk are also set out in a PrescQIPP bulletin.^9,15

The British Geriatrics Society Pharmacy Group lists resources to guide clinicians on medicines management and deprescribing in older adults.¹⁶

Deprescribing example

Taking benzodiazepines as an example for deprescribing, withdrawal should be considered if there is daytime sedation or impaired thought processes or movement. Using a benzodiazepine for sleeping or for anxiety disorder may also be reasons to consider stopping the drug. Stepwise withdrawal will generally be needed rather than immediate cessation, and the patient should be monitored for aspects such as anxiety, insomnia and agitation, and possibly for delirium, seizures or confusion.¹⁴