Are Falls and Fractures Associated with Cholinesterase Inhibitors and Antipsychotics?

Cholinesterase inhibitors (CIs; e.g., donepezil, galantamine, rivastigmine) and antipsychotic agents (APAs) often are prescribed to older adults with major neurocognitive and neuropsychiatric disorders. Both of these drug classes potentially increase risk for falls and fractures — APAs via their direct central nervous system effects and CIs via bradycardia and syncope. However, the extent to which falls and fractures might be related to patients' underlying neuropathology (i.e., confounding by indication) is unclear.

Taiwanese researchers identified more than 15,000 older adults (age, ≥65 in 2006) who had received at least one prescription each for a CI and an APA and had at least one fall or fracture between 2006 and 2017, but no falls or f…