For elderly, opioids tied to higher risk of fall-related injuries and deaths
Effect of opioids is similar to alcohol for slowing reflexes and affecting balance, Quebec doctor says
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 centres 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 per cent 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.
People who take opioids are often more frail because of their medical histories, and their underlying disability may also increase their risk of falls.- Brendan Saloner
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 (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin) or naproxen (Aleve).
"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 note 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 per cent of the patients were injured in falls and 59 per cent 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.
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Almost 5 per cent of the patients who had recently filled an opioid prescription had been injured in a fall, compared to 1.5 per cent 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.
One way to avoid the risk may be to try not to start opioids in the first place, said Dr. Jennifer Stevens, a researcher at Beth Israel Deaconess Medical Center and Harvard Medical School in 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 drugs for a long period of time, Stevens said by email. Patients should ask their doctors about alternatives, Stevens advised.
"There are a range of other medications that … may even be more helpful to acute pain, post surgical pain, and even chronic pain," Stevens said.