Recent opioid use and fall-related injury among older patients with trauma

• Published in: Canadian Medical Association journal (CMAJ) Vol. 190; no. 16; pp. E500 - E506
• Main Authors: Daoust, Raoul, MD MSc, Paquet, Jean, PhD, Moore, Lynne, PhD, Émond, Marcel, MD MSc, Gosselin, Sophie, MD, Lavigne, Gilles, DMD PhD, Choinière, Manon, PhD, Boulanger, Aline, MD, Mac-Thiong, Jean-Marc, MD, Chauny, Jean-Marc, MD MSc
• Format: Journal Article
• Language: English
• Published: Canada Joule Inc 23-04-2018; CMA Impact, Inc
• Subjects: Accidental falls; Accidental Falls - statistics & numerical data; Age; Aged; Aged, 80 and over; Analgesics, Opioid - adverse effects; Arthritis; Care and treatment; Clinical outcomes; Complications and side effects; Development and progression; Dosage and administration; Elderly patients; Falls; Female; Fractures; Fractures, Bone - epidemiology; Geriatrics; Health risk assessment; Hospitals; Humans; Injuries; Internal Medicine; Length of Stay - statistics & numerical data; Male; Narcotics; Older people; Opioids; Pain; Patients; Population; Prescription drugs; Psychotropic drugs; Quebec - epidemiology; Regression analysis; Retrospective Studies; Risk Factors; Sensitivity analysis; Systematic review; Trauma; Trauma Centers - statistics & numerical data; Womens health; Quebec; Canada; Sweden; Quebec Canada
• ISSN: 0820-3946; 1488-2329
• DOI: 10.1503/cmaj.171286

ABSTRACT BACKGROUND Evidence for an association between opioid use and risk of falls or fractures in older adults is inconsistent. We examine the association between recent opioid use and the risk, as well as the clinical outcomes, of fall-related injuries in a large trauma population of older adults. METHODS In a retrospective, observational, multicentre cohort study conducted on registry data, we included all patients aged 65 years and older who were admitted (hospital stay > 2 d) for injury in 57 trauma centres in the province of Quebec, Canada, between 2004 and 2014. We looked at opioid prescriptions filled in the 2 weeks preceding the trauma in patients who sustained a fall, compared with those who sustained an injury through another mechanism. RESULTS A total of 67 929 patients were retained for analysis. Mean age was 80.9 (± 8.0) years and 69% were women. The percentage of patients who had filled an opioid prescription in the 2 weeks preceding an injury was 4.9% (95% confidence interval [CI] 4.7%–5.1%) for patients who had had a fall, compared with 1.5% (95% CI 1.2%–1.8%) for those who had had an injury through another mechanism. After we controlled for confounding variables, patients who had filled an opioid prescription within 2 weeks before injury were 2.4 times more likely to have a fall rather than any other type of injury. For patients who had a fall-related injury, those who used opioids were at increased risk of in-hospital death (odds ratio 1.58; 95% CI 1.34–1.86). INTERPRETATION Recent opioid use is associated with an increased risk of fall and an increased likelihood of death in older adults.