Fall Risk and Medication Use Near End of Life Among Adults With Chronic Obstructive Pulmonary Disease.

Abstract

Background: Falls are frequent among people with chronic obstructive pulmonary disease (COPD) and associated with increased morbidity, mortality, and healthcare costs. Understanding modifiable medication factors that contribute to fall risk is an important step to developing fall prevention strategies for this highly susceptible group.

Methods: This is 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. We identified demographics, comorbidities, fall-risk increasing drug (FRID) burden, and the occurrence of injurious falls within the 2 years prior to the date of death. We defined injurious falls using published algorithms of International Classification of Disease codes.

Results: Of 8204 decedents with COPD, 2454 (30%) had an injurious fall in the two years before death, and FRID use was common among 65%. A higher percentage of patients with falls received prescriptions for anticonvulsants (35% vs 26%), antipsychotics (24% vs 13%), atypical antidepressants (28% vs 19%), tricyclic antidepressants (10% vs 5%) versus those without a fall. In multivariable logistic regression, after adjusting for confounders, FRID burden was associated with greater odds of injurious fall (odds ratio (OR) 1.07 (95% confidence interval (CI) 1.04-1.09).

Conclusion: Our findings highlight an opportunity for collaboration between pharmacists, pulmonologists, and patients to develop new processes to potentially deprescribe and optimize the use of FRIDs among patients with COPD to increase safety.