Opioid exposure is associated with risk for serious falls in all age groups, but the oldest patients have the most risk.

Few studies have been designed to examine age-related risk for falls associated with opioid use. In this population-based study, Australian researchers quantified age-related risk for serious falls (defined as hospitalisation, emergency department visit or death related to a fall) among 3.2 million adults who initiated prescription opioids between 2005 and 2018.

During a median follow up of 4.3 years, 506,000 serious falls occurred (5200 fatalities). Adjusted for multiple variables, risk for serious falls was significantly elevated in all age groups during exposure to opioids. Compared with young adults, people in the oldest age category (age, 85 years or older) had significantly higher risk for serious falls (rate ratio, 6.4). For all age groups, risk for serious falls was higher during the first month following opioid initiation (compared with later) and again was highest in the oldest age group. Risk also rose with increasing opioid doses. 

Comment: This population-based study confirms the association between opioid use and serious falls, especially during the first month after initiation. The effect is especially striking in older people, who are more likely to be frail and to have other predisposing conditions. When a course of opioids is absolutely necessary in such patients, we should review (with patients and their families) possible ways to reduce their risk for falling, tailored to their specific living environment and clinical characteristics.

Paul S. Mueller, MD, MPH, FACP, Regional Vice President – Southwest Wisconsin, Mayo Clinic Health System, La Crosse; Professor of Medicine and Biomedical Ethics, Mayo Clinic College of Medicine and Science, Rochester, USA.

Hopkins RE, et al. Age-related risk of serious fall events and opioid analgesic use. JAMA Intern Med 2024 Feb 19; e-pub (https://doi. org/10.1001/jamainternmed.2023.8154).

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine.