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.
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.
Authors: Kathleen W Saunders; Michael Von Korff; Cynthia I Campbell; Caleb J Banta-Green; Mark D Sullivan; Joseph O Merrill; Constance Weisner Journal: J Pain Date: 2012-01-29 Impact factor: 5.820
Authors: Christopher R Carpenter; Manish N Shah; Fredric M Hustey; Kennon Heard; Lowell W Gerson; Douglas K Miller Journal: J Gerontol A Biol Sci Med Sci Date: 2011-04-17 Impact factor: 6.053
Authors: Mitchell Kim; Stephen J Kaplan; Steven H Mitchell; Medley Gatewood; Itay Bentov; Katherine A Bennett; Carol A Crawford; Paul R Sutton; Diane Matsuwaka; Mamatha Damodarasamy; May J Reed Journal: Drugs Aging Date: 2017-10 Impact factor: 3.923
Authors: Aymen Ali Al-Qurain; Lemlem G Gebremichael; Mohammed S Khan; Desmond B Williams; Lorraine Mackenzie; Craig Phillips; Patrick Russell; Michael S Roberts; Michael D Wiese Journal: Int J Clin Pharm Date: 2020-11-18