Age-related risk of serious falls increases with opioid use

New research published in JAMA Internal Medicine shows that opioid analgesics elevate the likelihood of falls in all adult patients, but the greatest risk is among individuals aged 85 years and older.

The retrospective population-based study included more than 3 million Australians who initiated prescription opioid treatment from 2005 through 2018 in New South Wales.

Patients across the age spectrum were most in danger of falling within the first 28 days of the opioid exposure period. Overall, more than 506,500 serious falls were documented during the study period, including 5,210 resulting in death.

The incidence of serious falls was highest among older adults, underscoring the need for additional fall prevention measures in a population who is already vulnerable due to frailty, polypharmacy, and other factors.

The study authors emphasize, however, that more also needs to be done in terms of prevention education and strategies for younger adults. These individuals are at risk because of fewer former exposures at baseline and higher doses. Prescribers should carefully weigh the risks and benefits before initiating an opioid regimen, the investigators conclude, especially if patients have preexisting risk factors—such as older age—or if the plan is to give them high daily doses.

“Targeted falls prevention efforts may be most effective within the first month following opioid initiation,” authors wrote.