OR WAIT null SECS
Fall Prevention Strategies Needed for Adults With COPD
Within 2 years of death, fall-risk increasing drug burden was associated with greater odds of an injurious fall.
New research has found a large proportion of injurious falls, which were made more likely with high fall-risk increasing drug (FRID) burden, in adults with chronic obstructive pulmonary disease (COPD) near end of life.1
“Fall-risk increasing drugs are commonly prescribed to people with COPD because they experience a high number of symptoms and conditions that indicate use of these drugs,” lead investigator Cara L. McDermott, PharmD, PhD, assistant professor in medicine, Division of Geriatrics and Palliative Care, Duke University School of Medicine, wrote in a statement.2 “However, injuries from falls can lead to emergency department visits or hospitalization, resulting in a lower quality of life and increased health care costs.”
McDermott and colleagues conducted a retrospective cohort study using electronic health record data from a single health system linked to Washington State death certificates of adults ages 40 or older who died between 2014–2018 with COPD. They identified demographics, comorbidities, FRID burden, and the occurrence of injurious falls within the 2 years prior to death.1
The investigators found that of 8204 decedents with COPD, 2454 (30%) had an injurious fall in the 2 years before death, and FRID use was common among 65%. Compared with those without a fall, a greater proportion of those with falls were prescribed anticonvulsants (35% versus 26%), antipsychotics (24% versus 13%), atypical antidepressants (28% versus 19%), and tricyclic antidepressants (10% versus 5%). Multivariable logistic regression, after adjusting for confounders, revealed that FRID burden was associated with greater odds of an injurious fall (odds ratio, 1.07 [95% CI, 1.04–1.09]).1
McDermott and colleagues noted that dementia was a more common comorbidity among those with a fall compared to those who did not fall, aligning with previous research showing that patients living with dementia are 2 to 3 times more likely to fall compared to patients without dementia, as reduced cognition negatively impacts gait control.3
The investigators noted limitations to the study including the potential for patients to have received care in other health care systems not included in the 1 EHR used in the study.1 They also did not have information of comorbidity severity, COPD severity, or home oxygen use in the patient population. Data on filled prescriptions were also not indicative of whether the prescription was filled or taken.
“Our study compared the number of falls in the 2 years prior to death in people with COPD who used fall-risk increasing drugs to those with COPD who did not use these drugs. We found that the chance of a person falling increased relative to how many fall-risk increasing drugs they used,” McDermott added.2 “Pulmonologists and pharmacists need to collaborate with each other and with patients to develop fall prevention strategies and to increase patient safety by reducing the use of fall-risk increasing drugs and discussing other ways to mitigate fall risk.”
REFERENCES
McDermott CL, Feemster LC, Engelberg RA, Spece LJ, Donovan LM, Curtis JR. Fall Risk and Medication Use Near End of Life Among Adults With Chronic Obstructive Pulmonary Disease. Chronic Obstr Pulm Dis. 2024;11(6):604-610. doi:10.15326/jcopdf.2024.0551
Commonly prescribed medications increase fall risk and related injuries in people with COPD. News release. January 14, 2025. https://www.eurekalert.org/news-releases/1069403
Racey M,Markle-Reid M,Fitzpatrick-Lewis D,et al. Fall prevention in community-dwelling adults with mild to moderate cognitive impairment: a systematic review and meta-analysis. BMC Geriatr. 2021;21:689. doi: https://doi.org/10.1186/s12877-021-02641-9
