Risk of Injury Associated with Opioid Use in Older Adults

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 58; no. 9; pp. 1664 - 1670
• Main Authors: Buckeridge, David, Huang, Allen, Hanley, James, Kelome, Armel, Reidel, Kristen, Verma, Aman, Winslade, Nancy, Tamblyn, Robyn
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.09.2010; Wiley-Blackwell; Wiley Subscription Services, Inc
• Subjects: Aged; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - adverse effects; Biological and medical sciences; Conscious Sedation - adverse effects; Dose-Response Relationship, Drug; Female; Follow-Up Studies; General aspects; Geriatrics; Humans; Incidence; Injuries; injury; Male; Medical sciences; Miscellaneous; Narcotics; Older people; opioid; Opioids; Palliative Care - methods; pharmaceuticals; Prognosis; Proportional Hazards Models; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quebec - epidemiology; Retrospective Studies; Risk Factors; Time Factors; Wounds and Injuries - epidemiology; Wounds and Injuries - etiology; Quebec; Quebec Canada; Human; Drug; Injury; Use; opioid; Opiates; pharmaceuticals; Trauma; Gerontology; Association; Risk factor; Lesion; Elderly; Geriatrics
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/j.1532-5415.2010.03015.x

OBJECTIVES: To estimate the dose‐related risk of injuries in older adults associated with the use of low‐, medium‐, and high‐potency opioids. DESIGN: Historical population‐based cohort study: 2001 to 2003. SETTING: Quebec, Canada's, universal healthcare system. PARTICIPANTS: Four hundred three thousand three hundred thirty‐nine adults aged 65 and older. MEASUREMENTS: Population‐based health databases were used to measure preexisting risk factors for injuries in 2001/02 and drug use and injuries during follow‐up (2003). Type and dose of opioids were measured as time‐dependent variables, as were other drugs that may increase the risk of injury from sedating side‐effects or hypotension. The risk of injury per one adult dose increase in opioid dose was estimated using multivariate Cox proportional hazards models. RESULTS: During the follow‐up year, 50.7% of the study population were prescribed drugs with sedating side effects, 15.3% were prescribed an opioid, 20.7% were concurrently using more than one sedating medication, and 3.7% were treated for an injury, fractures (55.1%) being the most common. After adjusting for concurrent drug use and baseline risk factors, low‐ (hazard ratio (HR)=1.36, 95% confidence interval (CI)=1.33–1.39) and intermediate‐potency (HR=1.05, 95% CI=1.02–1.07) opioids were associated with the risk of injury. Use of codeine combinations was associated with the highest risk of injury, a 127% greater risk (HR=2.27, 95% CI=2.21–2.34) per one adult dose increase. (The mean World Health Organization standardized dose in the study population was 1.71 ± 0.85 adult doses.) CONCLUSION: Opioids increase the risk of injury in older adults, particularly codeine combinations.