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For Elderly, Opioids Tied to Higher Risk of Falls and Deaths

April 24, 2018

By Lisa Rapaport

(Reuters Health) - Elderly people who are prescribed opioids may be at higher risk for injuries from falls, some of which may be fatal, a Canadian analysis of trauma cases suggests.

Researchers studied more than 67,000 injured patients over age 65 who were admitted to trauma centers in Quebec between 2004 and 2014. The average age was 81.

Overall, people with a recent opioid prescription were 2.4 times more likely to have been injured in a fall than other trauma patients, the study found.

And among all patients with fall-related injuries, those with recent opioid prescriptions were 58 percent more likely to die in the hospital than patients who were not using these painkillers.

"The effect of opioids is similar to alcohol - your reflexes are slower and your balance is affected, which makes you more likely to fall," said lead study author Dr. Raoul Daoust of the University of Montreal in Quebec.

It's possible that the chronic pain or health problems that led to the opioid prescriptions - and not the painkillers themselves - might actually cause falls, Daoust said by email. But the results still suggest patients should consider using other pain relievers like acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs).

"Only take opioids if other painkillers do not work," Daoust advised.

Falls are a leading cause of disability and death among people 65 and older, researchers noted April 23 online in CMAJ.

While some previous research has linked opioid use to an increased risk of falls, results have been mixed and studies to date haven’t provided a clear picture of the severity of injuries or the risk of death for elderly patients.

In the current study, 92% of the patients were injured in falls and 59% of the patients required surgery. Half of them were hospitalized for at least 12 days.

The vast majority of these trauma patients had not been prescribed opioids within the two weeks prior to their injury.

Almost 5% of the patients who had recently filled an opioid prescription had been injured in a fall, compared to 1.5% of people with other types of injuries.

The study wasn't a controlled experiment designed to prove whether or how opioids might directly cause falls or fatalities, the authors note. Another limitation is that they examined prescription data, and it's possible some patients might not have taken opioids that doctors prescribed.

Still, the results suggest that patients should consider alternative painkillers when possible, and be aware of the potential risk of falls with opioids, said Brendan Saloner, a researcher at Johns Hopkins Bloomberg School of Public Health in Baltimore who wasn't involved in the study.

"Opioids act on the central nervous system and often have a sedating effect, so people may feel drowsier after taking opioids or may experience reduced motor functioning, which may cause them to lose their balance and become more at risk of falls," Saloner said by email.

"However, people who take opioids are often more frail because of their medical histories, and their underlying disability may also increase their risk of falls - for example, they may be people who use walkers or who have vision problems," Saloner added.


CMAJ 2018.

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