Thirty percent of patients with chronic obstructive pulmonary disease experienced injurious falls in their final 2 years of life, with higher risks linked to prescriptions for fall risk–increasing drugs such as anticonvulsants and benzodiazepines, according to a recent study. 

Researchers evaluated the association between fall risk–increasing drugs (FRIDs) and injurious falls in patients with chronic obstructive pulmonary disease (COPD) near the end of life. They conducted a retrospective cohort analysis using data from the University of Washington Medicine system, linking electronic health records (EHR) and Washington State death certificates for 8,204 patients with COPD who died between 2014 and 2018. Results of the research were published in Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation.

The primary objective of the study was to assess the relationship between FRID prescriptions and injurious falls in the last 2 years of life. COPD was defined by at least two International Classification of Diseases (ICD)-coded encounters, and injurious falls were identified using ICD codes for emergency department visits, hospitalizations, or outpatient visits with fall-related diagnoses such as fractures or brain injuries. The study included prescriptions for various FRID classes, such as anticonvulsants, opioids, benzodiazepines, and antidepressants. Researchers evaluated demographic and clinical factors, adjusting for comorbidities, race, marital status, and prior fall history.

The results indicated that 30% (n=2,454) of enrolled patients experienced an injurious fall, noted first study author Cara L. McDermott, PharmD, PhD, of the Division of Geriatrics and Palliative Care, Department of Medicine, and Department of Population Health Sciences at Duke University School of Medicine, and colleagues. Individuals who fell had a significantly higher FRID burden, with an average of 3.47 prescriptions compared to 2.85 in those without falls (P < .05). Anticonvulsants (35% vs. 26%), antipsychotics (24% vs. 13%), and tricyclic antidepressants (10% vs. 5%) were more frequently prescribed in the fall vs the nonfall group. Logistic regression analysis demonstrated an increased fall risk with FRID use (odds ratio = 1.07, 95% confidence interval = 1.04–1.09). Patients with falls were more likely to be Black, unmarried, and Medicaid-enrolled, and also had a higher prevalence of comorbidities—including dementia and diabetes—compared to those without falls.

This study highlighted the role of FRIDs in increasing fall risk among patients with COPD, emphasizing the need for targeted deprescribing strategies and interdisciplinary collaboration to reduce fall risk while managing symptoms. Limitations of the study included reliance on EHR data, absence of COPD severity metrics, and lack of pharmacy claims to confirm medication adherence. 

Full disclosures can be found in the published study.