Opioid use and fall risk in older adults

International study finds significant association between opioid use and falls, fall injuries and fractures
February 24, 2020

Compared to younger adults, those ages 65 and older report greater use of opioid medications for chronic pain, with around 25 percent using them for 90 days or longer. This extensive opioid use among older adults is a public health concern, in part because of its possible association with falls. Understanding this association is vital because falls are a major cause of injury, reduced quality of life and premature death among older adults. However, the associations between opioids and falls have been inconsistent, and risk levels of fall-related injuries, including fractures, remain largely unexplored.

To fill this gap, a new study led by Aya Yoshikawa, DrPH, PhD, a postdoctoral researcher in the Center for Population Health and Aging, systematically reviewed the current body of literature on opioid use and fall risk for older adults. The study was published in the Journal of Gerontology: Medical Sciences.

Yoshikawa and colleagues searched literature in nine databases looking for studies that covered opioid use, falls and fall injuries or fractures in populations of older adults. The researchers analyzed 36 studies from various countries, with sample sizes ranging from 124 to more than 400,000, in a wide array of settings including several in nursing homes and long-term care facilities.

“Our systematic review found an association between opioid use and falls, fall injuries and fractures,” Yoshikawa said. “Opioid use and fracture risk showed the strongest association, and higher daily opioid medication dosages may be attributed a greater risk for broken bones.”

The findings of this study are consistent with other research on medication use and fall risk. The researchers note that this study builds on the current body of knowledge by focusing on specific fall-related outcomes, which vary in severity in terms of outcome and recovery for the older adult. Additionally, finding an association between dosage and fall risk provides valuable insight for future research about opioid doses and user durations, especially in cases of long-term use.

The association between opioid use and fall-related injuries among older adults also points to a need for better clinical guidelines on prescribing opioids and managing possible health consequences. This study highlights the importance of alternative pain treatments, better opioid education and fall prevention programs for older adults. A clearer understanding of opioid use and fall risk and the guidance and resources needed by older adult patients could help improve health outcomes for the aging population.

Additional authors from the Texas A&M School of Public Health were Gilbert Ramirez, DrPH, Matthew Lee Smith, PhD, and Marcia Ory, PhD, Anas Nabil, and Sagar Jani along with Margaret Foster of the Texas A&M Medical Sciences Library.

— Rae Lynn Mitchell

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