Central nervous system medication use and incident mobility limitation in community elders: the health, aging, and body composition study

Abstract

SUMMARY Purpose To evaluate whether CNS medication use in older adults was associated with a higher risk of future incident mobility limitation. Methods This 5-year longitudinal cohort study included 3055 participants from the health, aging and body composition (Health ABC) study who were well-functioning at baseline. CNS medication use (benzodiazepine and opioid receptor agonists, antipsychotics, and antidepressants) was determined yearly (except year 4) during in-home or in-clinic interviews. Summated standardized daily doses (low, medium, and high) and duration of CNS drug use were computed. Incident mobility limitation was operationalized as two consecutive self-reports of having any difficulty walking 1/4 mile or climbing 10 steps without resting every 6 months after baseline. Multivariable Cox proportional hazard analyses were conducted adjusting for demographics, health behaviors, health status, and common indications for CNS medications. Results Each year at least 13.9% of participants used a CNS medication. By year 6, overall 49% had developed incident mobility limitation. In multivariable models, CNS medication users compared to never users showed a higher risk for incident mobility limitation (adjusted hazard ratio (Adj. HR) 1.28; 95% confidence interval (CI) 1.12–1.47). Similar findings of increased risk were seen in analyses examining dose– and duration–response relationships. Conclusions CNS medication use is independently associated with an increased risk of future incident mobility limitation in community dwelling elderly. Further studies are needed to determine the impact of reducing CNS medication exposure on mobility problems.

Impact of Drug–Drug and Drug–Disease Interactions on Gait Speed in Community-Dwelling Older Adults

“…For four conditions (i.e., falls in the previous year, heart failure, Parkinson’s disease, and syncope), reliable and valid self-reported information was collected directly from participants [15,16]. Renal impairment (estimated glomerular filtration rate [eGFR] < 30 mL/min) was calculated with the CKD-EPI Cystatin C equation using serum cystatin C values from blood draws taken at years 1, 3, and 4 [17,18].…”

Elderly Benzodiazepine Users at Increased Risk of Activity Limitations: Influence of Chronicity, Indications, and Duration of Action—The Three-City Cohort

“…In another longitudinal cohort, Boudreau et al did not find an association with mobility. 17 These last three longitudinal studies used a similar methodology with time-varying exposure that analyzes the immediate or short-term effect. In a prognostic score of 4-year risk of physical activity and basic activity limitations, Sarkisian et al found a significant effect of benzodiazepines for both outcomes with a greater effect of short-acting drugs for physical activities.…”

The Role of Opioid Analgesics in Geriatric Pain Management

“…Coadministration of opioids and other agents that affect the central nervous system (benzodiazepine receptor agonists, antipsychotics, tricyclic antidepressants, and selective serotonin reuptake inhibitors [SSRIs]) has also been associated with falls and fractures. 37,38 As such, the administration of ≥ 3 of central nervous system agents is now considered a clinically important drug-drug interaction in the 2015 American Geriatrics Society Beers Criteria, an explicit measure of potentially inappropriate prescribing in older adults. 29 …”