Pharmacoepidemiology of Falls and Fractures in Frail Older Stroke Patients: A Big Data Approach

Globally, stroke is a major cause of morbidity and mortality, with older adults being particularly vulnerable to stroke and long-term complications. Post-stroke management often involves multiple pharmacological interventions, including antihypertensive, antithrombotic, and lipid-lowering medications. Many patients also have comorbid conditions which require treatment with other medications (e.g., psychotropic and analgesic medications) which may increase their risk of falls and fractures. Pharmacoepidemiology is the study of the utilisation and real-world effects of medications and vaccines in populations. With the increasing availability of Big Data, researchers can now examine rare but clinically significant adverse outcomes associated with medication use. This project will leverage large, linked databases to investigate the risk of falls and fractures in frail older stroke patients exposed to specific medication classes. The student will work within the Big Data, Epidemiology and Prevention Division of the Stroke and Ageing Research (STAR) group, Monash University, to: 1) Conduct a systematic review of the published evidence on the association between medication use and fall-related outcomes in older adults post-stroke (Phase 1) 2) Analyse Big Data to examine the real-world impact of commonly prescribed medications (e.g., antihypertensives, antithrombotics, psychotropics, opioids) on falls and fractures in frail older stroke patients (Phase 2) 3) Apply advanced pharmacoepidemiological methods to assess potential causal relationships and quantify absolute and relative risks Following ethics approval, the student will access and analyse large-scale linked healthcare datasets. The research will involve state-of-the-art pharmacoepidemiological techniques, including propensity score matching, causal inference using observational data, and emulated target trials. The student will summarise their research findings in a thesis by publication and contribute to high-impact scientific literature. With supportive supervision, the student will develop the following skills and expertise: • Public health and pharmacoepidemiological research • Advanced statistical and analytical techniques for observational studies • Systematic review and meta-analysis methodologies • Scientific writing and publication in leading journals This project is most suitable for a PhD degree, but modifications can be made to accommodate a Master’s by Research program. The findings will provide critical real-world insights into medication safety in a vulnerable population and inform clinical guidelines to optimise post-stroke pharmacotherapy in frail older adults.