Development of the ADFICE_IT models for predicting falls and recurrent falls in community-dwelling older adults: pooled analyses of European cohorts with special attention to medication.

Background: Use of fall prevention strategies requires detection of high-risk patients. Our goal was to develop prediction models for falls and recurrent falls in community-dwelling older adults and to improve upon previous models by using a large, pooled sample and by considering a wide range of candidate predictors, including medications. Methods: Harmonized data from two Dutch (LASA, B-PROOF) and one German cohort (ActiFE Ulm) of adults aged ≥ 65 years were used to fit two logistic regression models: one for predicting any fall and another for predicting recurrent falls over one year. Model generalizability was assessed using internal-external cross-validation. Results: Data of 5722 participants were included in the analyses, of whom 1868 (34.7%) endured at least one fall and 702 (13.8%) endured a recurrent fall. Positive predictors for any fall were: educational status, depression, verbal fluency, functional limitations, falls history, and use of antiepileptics and drugs for urinary frequency and incontinence; negative predictors were: body mass index (BMI), grip strength, systolic blood pressure, and smoking. Positive predictors for recurrent falls were: educational status, visual impairment, functional limitations, urinary incontinence, falls history, and use of anti-Parkinson drugs, antihistamines, and drugs for urinary frequency and incontinence; BMI was a negative predictor. The average C-statistic value was 0.65 for the model for any fall and 0.70 for the model for recurrent falls. Conclusions: Compared with previous models, the model for recurrent falls performed favorably while the model for any fall performed similarly. Validation and optimization of the models in other populations is warranted.