Odds for injurious fall heightened with fall-risk increasing drug prescription in COPD
Key takeaways:
- Significantly more patients from the injurious fall group had all but one of the studied prescription classes than patients with no injurious falls.
- These included anticonvulsants, antipsychotics and more.
The adjusted likelihood for an injurious fall in adults with COPD was elevated with a fall-risk increasing drug prescription, according to results published in Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation.
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“We cannot modify all fall risk factors, but medications are a modifiable factor,” Cara L. McDermott, PharmD, PhD, assistant professor in medicine in the division of geriatrics and palliative care at Duke University School of Medicine, told Healio.

“While fall-risk increasing drugs (FRIDs) like opioids are certainly appropriate to use with patients with COPD, especially for patients with pain and/or severe dyspnea, it is important to minimize FRID burden whenever possible to try to further reduce fall risk,” McDermott continued. “That means using the lowest effective dose possible and, if a patient is taking multiple FRIDs, then evaluating whether each FRID still aligns with therapeutic needs and patient goals for care.”
Based on a database using records from both Washington State death certificates and the Washington Medicine System spanning 2014 to 2018, McDermott and colleagues evaluated 8,204 patients with COPD aged at least 40 years who died to uncover the prevalence of FRIDs among those with an injurious fall 2 years before dying and how FRIDs impact the odds for this type of fall.
“Falls can be a catastrophic event for patients and their family members,” McDermott said. “Furthermore, a fall, whether injurious or not, puts patients at risk for future falls. Falls cause significant morbidity and mortality, especially among frail patients.”
Researchers found reports of an injurious fall 2 years before death in almost one-third of the study population (30%; n = 2,454; mean age, 70.1 years; 61% men; 78% non-Hispanic white; 11% Black), whereas the remaining 5,750 patients (mean age, 70.2 years; 61% men; 84% non-Hispanic white; 6% Black) did not experience an injurious fall.
In addition to race, researchers noted differences between the patients who did vs. did not fall in the proportions of:
- married patients (25% vs. 40%);
- patients with some college education (39% vs. 43%);
- patients with Medicaid (30% vs. 19%);
- patients with private insurance (11% vs. 17%); and
- patients with a history of falling (23% vs. 4%).
Of the two sets of patients, the total average number of comorbidities was higher in the group reporting an injurious fall (2.81 vs. 2.46), according to the study.
Researchers observed a similar pattern in the average number of FRID prescriptions, with more in the group with vs. without an injurious fall (3.47 vs. 2.85).
When assessing patients with prescriptions for a FRID (65%), researchers found that significantly (P < .05) more patients from the injurious fall group had all but one of the studied prescription classes than patients with no injurious falls. These medications included:
- opioids (68% vs. 64%);
- benzodiazepines (40% vs. 34%);
- anticonvulsants (35% vs. 26%);
- antispasmodics (30% vs. 25%);
- atypical antidepressants (28% vs. 19%);
- selective serotonin reuptake inhibitors (27% vs. 20%);
- antipsychotics (24% vs. 13%);
- sedative hypnotics (11% vs. 8%);
- tricyclic antidepressants (10% vs. 5%); and
- serotonin norepinephrine reuptake inhibitors (9% vs. 5%).
The one FRID class that did not significantly differ between the injurious fall group and the group without an injurious fall was antihypertensives (64% vs. 65%), researchers reported.
“The study findings were surprising because while we thought higher FRID burden may be associated with falls in this patient population, we did not realize that so many patients near end of life were receiving multiple FRID prescriptions and experiencing falls,” McDermott told Healio. “This highlights an area for future medication and patient safety interventions.”
Notably, the likelihood for an injurious fall was elevated with a FRID prescription (OR = 1.07; 95% CI, 1.04-1.09) in a confounder-adjusted model, according to the study.
“Future studies will use prospective rather than retrospective design, which will allow us to follow people and intervene prior to falls, if possible,” McDermott told Healio. “In future studies, we will be using medication administration records in conjunction with electronic health records to evaluate if/how the medications were taken, patient goals for care around their medications and the circumstances under which patients fall.”
Reference:
- Commonly prescribed medications increase fall risk and related injuries in people with COPD. https://www.copdfoundation.org/About-Us/Press-Room/Press-Releases/Article/2090/Commonly-prescribed-medications-increase-fall-risk-and-related-injuries-in-peop.aspx. Published Jan. 14, 2025. Accessed Jan. 14, 2025.
For more information:
Cara L. McDermott, PharmD, PhD, can be reached at cara.mcdermott@duke.edu.