For elderly, opioids tied to higher risk of fall-related injuries and deaths

Elderly people who are prescribed opioidsmay be at higher risk for injuries from falls, some of which maybe fatal, a Canadian analysis of trauma cases suggests.

Researchers studied more than 67,000 injured patients overage 65 who were admitted to trauma centres in Quebec between2004 and 2014. The average age was 81.

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

And among all patients with fall-related injuries, thosewith recent opioid prescriptions were 58 per cent more likely todie in the hospital than patients who were not using thesepainkillers.

"The effect of opioids is similar to alcohol your reflexesare slower and your balance is affected, which makes you morelikely to fall," said lead study author Dr. Raoul Daoust of theUniversity of Montreal in Quebec.

People who take opioids are often more frailbecause of their medical histories, and their underlyingdisability may also increase their risk of falls.-BrendanSaloner

It's possible that the chronic pain or health problems thatled to the opioid prescriptions and not the painkillersthemselves might actually cause falls, Daoust said by email.But the results still suggest patients should consider usingother pain relievers like acetaminophen (Tylenol) ornonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen(Motrin) or naproxen (Aleve).

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

Falls are a leading cause of disability and death amongpeople 65 and older, researchers note in CMAJ.

Sedating effect

While some previous research has linked opioid use to anincreased risk of falls, results have been mixed and studies todate haven't provided a clear picture of the severity ofinjuries or the risk of death for elderly patients.

In the current study, 92 per cent of the patients wereinjured in falls and 59 per cent of the patients requiredsurgery. Half of them were hospitalized for at least 12 days.

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

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

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

Still, the results suggest that patients should consideralternative painkillers when possible, and be aware of thepotential risk of falls with opioids, said Brendan Saloner, aresearcher at Johns Hopkins Bloomberg School of Public Health inBaltimore who wasn't involved in the study.

"Opioids act on the central nervous system and often have asedating effect, so people may feel drowsier after takingopioids or may experience reduced motor functioning, which maycause them to lose their balance and become more at risk offalls," Saloner said by email.

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

One way to avoid the risk may be to try not to start opioidsin the first place, said Dr. Jennifer Stevens, a researcher atBeth Israel Deaconess Medical Center and Harvard Medical Schoolin Boston who wasn't involved in the study.

Many patients get started on opioids after a hospital stay,and once they start they run the risk of staying on the drugsfor a long period of time, Stevens said by email. Patientsshould ask their doctors about alternatives, Stevens advised.

"There are a range of other medications that may evenbe more helpful to acute pain, post surgical pain, and evenchronic pain," Stevens said.