Age-Related Risk of Serious Fall Events and Opioid Analgesic Use

Ria E. Hopkins; Chrianna Bharat; Luke Buizen; Jacqueline Close; Rebecca Ivers; Brian Draper; Sallie-Anne Pearson; Louisa Degenhardt; Natasa Gisev

doi:10.1001/jamainternmed.2023.8154

Comment

Australian Institute of Health and Welfare. 听Trends in Hospitalised Injury, Australia 2007-08 to 2016-17. AIHW; 2019.

Australian Institute of Health and Welfare. 听Trends in Injury Deaths, Australia, 1999-00 to 2016-17. AIHW; 2019.

Australian Institute of Health and Welfare. 听滨苍箩耻谤测 in Australia. AIHW; 2022.

Verma 听SK锘�, Willetts 听JL锘�, Corns 听HL锘�, Marucci-Wellman 听HR锘�, Lombardi 听DA锘�, Courtney 听TK锘�. 听Falls and fall-related injuries among community-dwelling adults in the United States.听锘� 听PLoS One. 2016;11(3):e0150939. doi:锘�

James 听MK锘�, Victor 听MC锘�, Saghir 听SM锘�, Gentile 听PA锘�. 听Characterization of fall patients: does age matter?听锘� 听J Safety Res. 2018;64:83-92. doi:锘�

Australian Institute of Health and Welfare. 听Trends in Hospitalised Injury Due to Falls in Older People 2007-08 to 2016-17. AIHW; 2019.

Harvey 听LA锘�, Close 听JCT锘�. 听Traumatic brain injury in older adults: characteristics, causes and consequences.听锘� 听滨苍箩耻谤测. 2012;43(11):1821-1826. doi:锘�

Benyamin 听R锘�, Trescot 听AM锘�, Datta 听S锘�, 听et al. 听Opioid complications and side effects.听锘� 听Pain Physician. 2008;11(2)(suppl):S105-S120. doi:锘�

Dhingra 听L锘�, Ahmed 听E锘�, Shin 听J锘�, Scharaga 听E锘�, Magun 听M锘�. 听Cognitive effects and sedation.听锘� 听Pain Med. 2015;16(suppl 1):S37-S43. doi:锘�

10.

Degenhardt 听L锘�, Gisev 听N锘�, Cama 听E锘�, Nielsen 听S锘�, Larance 听B锘�, Bruno 听R锘�. 听The extent and correlates of community-based pharmaceutical opioid utilisation in Australia.听锘� 听Pharmacoepidemiol Drug Saf. 2016;25(5):521-538. doi:锘�

11.

Gisev 听N锘�, Pearson 听SA锘�, Blanch 听B锘�, 听et al. 听Initiation of strong prescription opioids in Australia: cohort characteristics and factors associated with the type of opioid initiated.听锘� 听Br J Clin Pharmacol. 2016;82(4):1123-1133. doi:锘�

12.

Hollingworth 听SA锘�, Gray 听PD锘�, Hall 听WD锘�, Najman 听JM锘�. 听Opioid analgesic prescribing in Australia: a focus on gender and age.听锘� 听Pharmacoepidemiol Drug Saf. 2015;24(6):628-636. doi:锘�

13.

Roxburgh 听A锘�, Bruno 听R锘�, Larance 听B锘�, Burns 听L锘�. 听Prescription of opioid analgesics and related harms in Australia.听锘� 听Med J Aust. 2011;195(5):280-284. doi:锘�

14.

Blyth 听FM锘�, Cumming 听R锘�, Mitchell 听P锘�, Wang 听JJ锘�. 听Pain and falls in older people.听锘� 听Eur J Pain. 2007;11(5):564-571. doi:锘�

15.

Deandrea 听S锘�, Bravi 听F锘�, Turati 听F锘�, Lucenteforte 听E锘�, La Vecchia 听C锘�, Negri 听E锘�. 听Risk factors for falls in older people in nursing homes and hospitals: a systematic review and meta-analysis.听锘� 听Arch Gerontol Geriatr. 2013;56(3):407-415. doi:锘�

16.

Deandrea 听S锘�, Lucenteforte 听E锘�, Bravi 听F锘�, Foschi 听R锘�, La Vecchia 听C锘�, Negri 听E锘�. 听Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis.听锘� 听贰辫颈诲别尘颈辞濒辞驳测. 2010;21(5):658-668. doi:锘�

17.

Leveille 听SG锘�, Jones 听RN锘�, Kiely 听DK锘�, 听et al. 听Chronic musculoskeletal pain and the occurrence of falls in an older population.听锘� 听闯础惭础. 2009;302(20):2214-2221. doi:锘�

18.

Page 听AT锘�, Falster 听MO锘�, Litchfield 听M锘�, Pearson 听SA锘�, Etherton-Beer 听C锘�. 听Polypharmacy among older Australians, 2006-2017: a population-based study.听锘� 听Med J Aust. 2019;211(2):71-75. doi:锘�

19.

Stubbs 听B锘�, Binnekade 听T锘�, Eggermont 听L锘�, Sepehry 听AA锘�, Patchay 听S锘�, Schofield 听P锘�. 听Pain and the risk for falls in community-dwelling older adults: systematic review and meta-analysis.听锘� 听Arch Phys Med Rehabil. 2014;95(1):175-187.e9. doi:锘�

20.

Bloch 听F锘�, Thibaud 听M锘�, Dugu茅听B锘�, Br猫que 听C锘�, Rigaud 听AS锘�, Kemoun 听G锘�. 听Psychotropic drugs and falls in the elderly people: updated literature review and meta-analysis.听锘� 听J Aging Health. 2011;23(2):329-346. doi:锘�

21.

Seppala 听LJ锘�, van de Glind 听EMM锘�, Daams 听JG锘�, 听et al; EUGMS Task and Finish Group on Fall-Risk-Increasing Drugs. 听Fall-risk鈥搃ncreasing drugs: a systematic review and meta-analysis: III. Others.听锘� 听J Am Med Dir Assoc. 2018;19(4):372.e1-372.e8. doi:锘�

22.

Yoshikawa 听A锘�, Ramirez 听G锘�, Smith 听ML锘�, 听et al. 听Opioid use and the risk of falls, fall injuries and fractures among older adults: a systematic review and meta-analysis.听锘� 听J Gerontol A Biol Sci Med Sci. 2020;75(10):1989-1995. doi:锘�

23.

Mod茅n 听B锘�, Merlo 听J锘�, Ohlsson 听H锘�, Rosvall 听M锘�. 听Psychotropic drugs and falling accidents among the elderly: a nested case control study in the whole population of Scania, Sweden.听锘� 听J Epidemiol Community Health. 2010;64(5):440-446. doi:锘�

24.

S枚derberg 听KC锘�, Laflamme 听L锘�, M枚ller 听J锘�. 听Newly initiated opioid treatment and the risk of fall-related injuries: a nationwide, register-based, case-crossover study in Sweden.听锘� 听CNS Drugs. 2013;27(2):155-161. doi:锘�

25.

Close 听JCT锘�, Hooper 听R锘�, Glucksman 听E锘�, Jackson 听SHD锘�, Swift 听CG锘�. 听Predictors of falls in a high risk population: results from the prevention of falls in the elderly trial (PROFET).听锘� 听Emerg Med J. 2003;20(5):421-425. doi:锘�

26.

Gisev 听N锘�, Pearson 听SA锘�, Dobbins 听T锘�, 听et al. 听Cohort profile: POPPY II鈥攁 population-based cohort examining the patterns and outcomes of prescription opioid use in New South Wales, Australia.听锘� 听叠惭闯 Open. 2023;13(5):e068310. doi:锘�

27.

Gisev 听N锘�, Pearson 听SA锘�, Dobbins 听T锘�, 听et al. 听Combating escalating harms associated with pharmaceutical opioid use in Australia: the POPPY II study protocol.听锘� 听叠惭闯 Open. 2018;8(12):e025840. doi:锘�

28.

Langan 听SM锘�, Schmidt 听SA锘�, Wing 听K锘�, 听et al. 听The reporting of studies conducted using observational routinely collected health data statement for pharmacoepidemiology (RECORD-PE).听锘� 听叠惭闯. 2018;363:k3532. doi:锘�

29.

Lalic 听S锘�, Ilom盲ki 听J锘�, Bell 听JS锘�, Korhonen 听MJ锘�, Gisev 听N锘�. 听Prevalence and incidence of prescription opioid analgesic use in Australia.听锘� 听Br J Clin Pharmacol. 2019;85(1):202-215. doi:锘�

30.

Australian Bureau of Statistics. 3101.0鈥擜ustralian Demographic Statistics, Jun 2018. Accessed August 2, 2023.

31.

Pharmaceutical Benefits Scheme. About the PBS. Accessed April 29, 2023.

32.

Gisev 听N锘�, Pearson 听SA锘�, Karanges 听EA锘�, 听et al. 听To what extent do data from pharmaceutical claims under-estimate opioid analgesic utilisation in Australia?听锘� 听Pharmacoepidemiol Drug Saf. 2018;27(5):550-555. doi:锘�

33.

Bharat 听C锘�, Degenhardt 听L锘�, Pearson 听SA锘�, 听et al. 听A data-informed approach using individualised dispensing patterns to estimate medicine exposure periods and dose from pharmaceutical claims data.听锘� 听Pharmacoepidemiol Drug Saf. 2023;32(3):352-365. doi:

34.

Manchikanti 听L锘�, Kaye 听AM锘�, Knezevic 听NN锘�, 听et al. 听Responsible, safe, and effective prescription of opioids for chronic non-cancer pain: American Society of Interventional Pain Physicians (ASIPP) guidelines.听锘� 听Pain Physician. 2017;20(2S):S3-S92. doi:锘�

35.

Australian Bureau of Statistics. 1270.0.55.005鈥擜ustralian Statistical Geography Standard (ASGS): volume 鈥攔emoteness structure, 2016. Accessed Jan 29, 2021.

36.

Pink 听B锘�. Socio-economic indexes for areas (SEIFA) 2011. Accessed August 2, 2023.

37.

Fastbom 听J锘�, Schmidt 听I锘�. 听Indikatorer f枚r God L盲kemedelsterapi Hos 脛ldre. The Swedish National Board of Health and Welfare; 2010.

38.

de Vries 听M锘�, Seppala 听LJ锘�, Daams 听JG锘�, van de Glind 听EMM锘�, Masud 听T锘�, van der Velde 听N锘�; EUGMS Task and Finish Group on Fall-Risk-Increasing Drugs. 听Fall-risk-increasing drugs: a systematic review and meta-analysis: I. cardiovascular drugs.听锘� 听J Am Med Dir Assoc. 2018;19(4):371.e1-371.e9. doi:锘�

39.

Seppala 听LJ锘�, Wermelink 听AMAT锘�, de Vries 听M锘�, 听et al; EUGMS task and Finish group on fall-risk-increasing drugs. 听Fall-risk-increasing drugs: a systematic review and meta-analysis: II. Psychotropics.听锘� 听J Am Med Dir Assoc. 2018;19(4):371.e11-371.e17. doi:锘�

40.

Gilbert 听T锘�, Neuburger 听J锘�, Kraindler 听J锘�, 听et al. 听Development and validation of a hospital frailty risk score focusing on older people in acute care settings using electronic hospital records: an observational study.听锘� 听尝补苍肠别迟. 2018;391(10132):1775-1782. doi:锘�

41.

Street 听A锘�, Maynou 听L锘�, Gilbert 听T锘�, Stone 听T锘�, Mason 听S锘�, Conroy 听S锘�. 听The use of linked routine data to optimise calculation of the Hospital Frailty Risk score on the basis of previous hospital admissions: a retrospective observational cohort study.听锘� 听尝补苍肠别迟 Healthy Longev. 2021;2(3):e154-e162. doi:锘�

42.

VanderWeele 听TJ锘�, Ding 听P锘�. 听Sensitivity analysis in observational research: introducing the E-Value.听锘� 听Ann Intern Med. 2017;167(4):268-274. doi:锘�

43.

Court-Brown 听CM锘�, Clement 听ND锘�, Duckworth 听AD锘�, Biant 听LC锘�, McQueen 听MM锘�. 听The changing epidemiology of fall-related fractures in adults.听锘� 听滨苍箩耻谤测. 2017;48(4):819-824. doi:锘�

44.

Ensrud 听KE锘�. 听贰辫颈诲别尘颈辞濒辞驳测 of fracture risk with advancing age.听锘� 听J Gerontol A Biol Sci Med Sci. 2013;68(10):1236-1242. doi:锘�

45.

Vieira 听ER锘�, Palmer 听RC锘�, Chaves 听PHM锘�. 听Prevention of falls in older people living in the community.听锘� 听叠惭闯. 2016;353:i1419. doi:锘�

46.

de Jong 听MR锘�, Van der Elst 听M锘�, Hartholt 听KA锘�. 听Drug-related falls in older patients: implicated drugs, consequences, and possible prevention strategies.听锘� 听Ther Adv Drug Saf. 2013;4(4):147-154. doi:锘�

47.

Karlsson 听MK锘�, Magnusson 听H锘�, von Schewelov 听T锘�, Rosengren 听BE锘�. 听Prevention of falls in the elderly鈥揳 review.听锘� 听Osteoporos Int. 2013;24(3):747-762. doi:锘�

48.

Hopewell 听S锘�, Adedire 听O锘�, Copsey 听BJ锘�, 听et al. 听Multifactorial and multiple component interventions for preventing falls in older people living in the community.听锘� 听Cochrane Database Syst Rev. 2018;7(7):CD012221. doi:

49.

Guirguis-Blake 听JM锘�, Michael 听YL锘�, Perdue 听LA锘�, Coppola 听EL锘�, Beil 听TL锘�. 听Interventions to prevent falls in older adults: updated evidence report and systematic review for the US Preventive Services Task Force.听锘� 听闯础惭础. 2018;319(16):1705-1716. doi:锘�

50.

Karttunen 听N锘�, Lihavainen 听K锘�, Sipil盲听S锘�, Rantanen 听T锘�, Sulkava 听R锘�, Hartikainen 听S锘�. 听Musculoskeletal pain and use of analgesics in relation to mobility limitation among community-dwelling persons aged 75 years and older.听锘� 听Eur J Pain. 2012;16(1):140-149. doi:锘�

51.

Cheng 听S锘�, Siddiqui 听TG锘�, Gossop 听M锘�, Stavem 听K锘�, Kristoffersen 听ES锘�, Lundqvist 听C锘�. 听Health-related quality of life in hospitalized older patients with versus without prolonged use of opioid analgesics, benzodiazepines, and z-hypnotics: a cross-sectional study.听锘� 听BMC Geriatr. 2020;20(1):425. doi:锘�

52.

Freiberger 听E锘�, Sieber 听CC锘�, Kob 听R锘�. 听Mobility in older community-dwelling persons: a narrative review.听锘� 听Front Physiol. 2020;11:881. doi:锘�

53.

Talbot 听LA锘�, Musiol 听RJ锘�, Witham 听EK锘�, Metter 听EJ锘�. 听Falls in young, middle-aged and older community dwelling adults: perceived cause, environmental factors and injury.听锘� 听BMC Public Health. 2005;5(1):86. doi:锘�

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Original Investigation

February 19, 2024

Age-Related Risk of Serious Fall Events and Opioid Analgesic Use

Ria E.听Hopkins,听PhD¹; 颁丑谤颈补苍苍补听叠丑补谤补迟,听笔丑顿¹; 尝耻办别听叠耻颈锄别苍,听惭叠颈辞蝉迟补迟¹; et al 闯补肠辩耻别濒颈苍别听颁濒辞蝉别,听惭顿²; 搁别产别肠肠补听滨惫别谤蝉,听笔丑顿³; 叠谤颈补苍听顿谤补辫别谤,听惭顿⁴; 厂补濒濒颈别-础苍苍别听笔别补谤蝉辞苍,听笔丑顿^3,5; 尝辞耻颈蝉补听顿别驳别苍丑补谤诲迟,听笔丑顿¹; 狈补迟补蝉补听骋颈蝉别惫,听笔丑顿¹

Author Affiliations Article Information

¹National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
²Neuroscience Research Australia, UNSW Sydney, Sydney, New South Wales, Australia
³School of Population Health, UNSW Sydney, Sydney, New South Wales, Australia
⁴School of Clinical Medicine, Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney, New South Wales, Australia
⁵Menzies Centre for Health Policy, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia

JAMA Intern Med. 2024;184(4):394-401. doi:10.1001/jamainternmed.2023.8154

Key Points

Question听 What is the association between age-related risk of serious fall events and opioid analgesic use?

Findings听 In this population-based cohort study of 3.2 million people who initiated prescription opioid treatment, opioid exposure was associated with increased risk of serious fall events among adults of all ages. Risk significantly increased with age and within the first 28 days of commencing opioid use.

Meaning听 The results of this study suggest that fall risk should be considered when prescribing opioids in adults, particularly in the first 4 weeks of treatment, and among individuals with preexisting risk factors for falls, including older age.

Abstract

Importance听 Opioid analgesics may be associated with increased risk of falls, particularly among older adults.

Objective听 To quantify the age-related risk of serious fall events among adults prescribed opioids by opioid exposure, time from initiation, and daily dose.

Design, Setting, and Participants听 This population-based cohort study conducted in New South Wales, Australia, used data linking national pharmaceutical claims to national and state datasets, including information on sociodemographic characteristics, clinical characteristics, medicines use, health services utilization, and mortality (POPPY II study). It included adults (18 years or older) who initiated prescription opioid treatment, which was defined as no prior dispensing during the preceding 365 days, between January 1, 2005, and December 31, 2018. Data were analyzed from February to June 2023.

Exposure听 Time-dependent periods of opioid exposure were evaluated from dispensing records.

Main Outcome and Measures听 Serious fall events identified from emergency department, hospitalization, and mortality records. Negative binomial models were used to assess associations between time-dependent opioid exposure (overall, by time from initiation, and by dose), age, and risk of fall events. Models were adjusted for known fall risk factors, including other fall risk鈥搃ncreasing drugs, frailty risk, and prior serious fall events.

Results听 The cohort comprised 3鈥�212鈥�369 individuals who initiated prescription opioid treatment (1鈥�702鈥�332 women [53%]; median [IQR] age at initiation, 49 [32-65] years). Overall, 506鈥�573 serious fall events were identified, including 5210 fatal falls. During exposure to opioids, the risk of serious fall events was elevated among all age groups; compared with the group aged 18 to 44 years, this risk was highest among those 85 years or older (adjusted incident rate ratio, 6.35; 95% CI, 6.20-6.51). Across all age groups, the first 28 days following opioid initiation was a time of increased serious fall risk; this risk increased with age. Among individuals aged 18 to 84 years, associations were identified between higher daily opioid doses and serious fall events.

Conclusions and Relevance听 The results of this cohort study suggest that prescription opioids were associated with increased risk of serious fall events among adults of all ages, with individuals 85 years or older at greatest risk. These risks should be considered when prescribing opioids, particularly for individuals with preexisting risk factors or when opioids are prescribed at higher doses. Targeted falls prevention efforts may be most effective within the first month following opioid initiation.

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