Opioids and Falls Risk in Older Adults: A Narrative Review

Virnes, Roosa-Emilia; Tiihonen, Miia; Karttunen, Niina; Poelgeest, Eveline P. van; Velde, N. van der; Hartikainen, Sirpa

doi:10.1007/s40266-022-00929-y

Cited by 32 publications

(20 citation statements)

References 59 publications

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“…Some analgesics, and in particular opioids, increase fall risk [ 182 ]. The mechanisms of fall risk associated with opioids in older adults include sedation, orthostatic hypotension and hyponatremia.…”

Section: Management and Interventionsmentioning

confidence: 99%

World guidelines for falls prevention and management for older adults: a global initiative

et al. 2022

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Background falls and fall-related injuries are common in older adults, have negative effects on functional independence and quality of life and are associated with increased morbidity, mortality and health related costs. Current guidelines are inconsistent, with no up-to-date, globally applicable ones present. Objectives to create a set of evidence- and expert consensus-based falls prevention and management recommendations applicable to older adults for use by healthcare and other professionals that consider: (i) a person-centred approach that includes the perspectives of older adults with lived experience, caregivers and other stakeholders; (ii) gaps in previous guidelines; (iii) recent developments in e-health and (iv) implementation across locations with limited access to resources such as low- and middle-income countries. Methods a steering committee and a worldwide multidisciplinary group of experts and stakeholders, including older adults, were assembled. Geriatrics and gerontological societies were represented. Using a modified Delphi process, recommendations from 11 topic-specific working groups (WGs), 10 ad-hoc WGs and a WG dealing with the perspectives of older adults were reviewed and refined. The final recommendations were determined by voting. Recommendations all older adults should be advised on falls prevention and physical activity. Opportunistic case finding for falls risk is recommended for community-dwelling older adults. Those considered at high risk should be offered a comprehensive multifactorial falls risk assessment with a view to co-design and implement personalised multidomain interventions. Other recommendations cover details of assessment and intervention components and combinations, and recommendations for specific settings and populations. Conclusions the core set of recommendations provided will require flexible implementation strategies that consider both local context and resources.

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Section: Management and Interventionsmentioning

confidence: 99%

World guidelines for falls prevention and management for older adults: a global initiative

et al. 2022

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“…A significant proportion of MRED-ADE consequences were falls or fractures (156 cases, 26.8%), bleeding (118 cases, 20.2%), and hypoglycemia (34 cases, 5.8%), and these were mostly wellknown high-alert medication-related outcomes (Sodré Alves et al, 2021;Virnes et al, 2022). Multivariate results identified high-alert medication and some potentially inappropriate medications in older adults as predictors of MRED.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and predictors of medication-related emergency department visit in older adults: A multicenter study linking national claim database and hospital medical records

Park

Kim²,

Ah³

et al. 2022

Front. Pharmacol.

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Objectives: Older adults are more likely to experience drug-related problems (DRP), which could lead to medication-related emergency department visits (MRED). To properly evaluate MRED, the entire history of drug use should be evaluated in a structured manner. However, limited studies have identified MRED with complete prescription records. We aimed to evaluate the prevalence and risk factors of MRED among community-dwelling older patients by linking national claims data and electronic medical records using a standardized medication related admission identification method.Methods: We included older patients who visited the emergency departments of four participating hospitals in 2019. Among the 54,034 emergency department (ED) visitors, we randomly selected 6,000 patients and structurally reviewed their medical records using a standardized MRED identification method after linking national claims data and electronic medical records. We defined and categorized MRED as ED visits associated with adverse drug events and those caused by the underuse of medication, including treatment omission and noncompliance and assessed as having probable or higher causality. We assessed preventability using Schumock and Thornton criteria.Results: MRED was observed in 14.3% of ED visits, of which 76% were preventable. In addition, 32.5% of MRED cases were related to underuse or noncompliance, and the rest were related to adverse drug events. Use of antipsychotics, benzodiazepines, anticoagulants, traditional nonsteroidal anti-inflammatory drugs without the use of proton pump inhibitors, P2Y12 inhibitors, insulin, diuretics, and multiple strong anticholinergic drugs were identified as predictors of MRED.Conclusion: One in seven cases of ED visits by older adults were medication related and over three-quarters of them were preventable. These findings suggest that DRPs need to be systemically screened and intervened in older adults who visit ED.

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“…reduced productive time or increased disability) [ 12 ]. Older people are more vulnerable to commonly reported adverse events and harms associated with opioid use, including sedation, dizziness, and respiratory suppression [ 13 ], as well as falls [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

TANGO: Development of Consumer Information Leaflets to Support TAperiNG of Opioids in Older Adults with Low Back Pain and Hip and Knee Osteoarthritis

Marcelo

Hunter

et al. 2023

Drugs Aging

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Introduction Globally, the rate of opioid prescription is high for chronic musculoskeletal conditions despite guidelines recommending against their use as their adverse effects outweigh their modest benefit. Deprescribing opioids is a complex process that can be hindered by multiple prescriber- and patient-related barriers. These include fear of the process of, or outcomes from, weaning medications, or a lack of ongoing support. Thus, involving patients, their carers, and healthcare professionals (HCPs) in the development of consumer materials that can educate and provide support for patients and HCPs over the deprescribing process is critical to ensure that the resources have high readability, usability, and acceptability to the population of interest. Objective This study aimed to (1) develop two educational consumer leaflets to support opioid tapering in older people with low back pain (LBP) and hip or knee osteoarthritis (HoKOA), and (2) evaluate the perceived usability, acceptability, and credibility of the consumer leaflets from the perspective of consumers and HCPs. Design This was an observational survey involving a consumer review panel and an HCP review panel. Participants 30 consumers (and/or their carers) and 20 HCPs were included in the study. Consumers were people older than 65 years of age who were currently experiencing LBP or HoKOA, and with no HCP background. Carers were people who provided unpaid care, support, or assistance to an individual meeting the inclusion criteria for consumers. HCPs included physiotherapists ( n = 9), pharmacists ( n = 7), an orthopaedic surgeon ( n = 1), a rheumatologist ( n = 1), nurse practitioner ( n = 1) and a general practitioner ( n = 1), all with at least three years of clinical experience and who reported working closely with this target patient population within the last 12 months. Methods Prototypes of two educational consumer leaflets (a brochure and a personal plan) were developed by a team of LBP, OA, and geriatric pharmacotherapy researchers and clinicians. The leaflet prototypes were evaluated by two separate chronological review panels involving (1) consumers and/or their carers, and (2) HCPs. Data collection for both panels occurred via an online survey. Outcomes were the perceived usability, acceptability, and credibility of the consumer leaflets. Feedback received from the consumer panel was used to refine the leaflets, before circulating the leaflets for further review by the HCP panel. Additional feedback from the HCP review panel was then used to refine the final versions of the consumer leaflets. Results Both consumers and HCPs perceived the leaflets and personal plan to be usable, acceptable, and credible. Consumers rated the b...

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Opioids and Falls Risk in Older Adults: A Narrative Review

Cited by 32 publications

References 59 publications

World guidelines for falls prevention and management for older adults: a global initiative

World guidelines for falls prevention and management for older adults: a global initiative

Prevalence and predictors of medication-related emergency department visit in older adults: A multicenter study linking national claim database and hospital medical records

TANGO: Development of Consumer Information Leaflets to Support TAperiNG of Opioids in Older Adults with Low Back Pain and Hip and Knee Osteoarthritis

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