Correlation Between Fall Risk and Opioid Use in Older Adults

Although pain treatment is important for older adults (OAs), adverse events such as falls may be a result of pain and opioid use, according to findings published in Drugs & Aging.

For nociceptive pain, opioids are effective, but researchers noted that for neuropathic pain the evidence is not substantial.

In an effort to improve decision-making for prescribing and deprescribing opioids among the the OA populations, researchers conducted a narrative literature review which summarizes existing evidence on opioid-related fall risk, including pharmacodynamics and pharmacokinetics.

Researchers pulled relevant literature in Scopus and PubMed from December 2020 to evaluate fall-related adverse effects associated with opioid use. The authors noted fall risk is increased by opioid use through orthostatic hypotension, drowsiness, and hyponatremia due to weak opioids.

When prescribing opioids researchers advised to keep metabolic genetic variation in mind and start with lower dosages. While fall risk is most prominent in OAs already prone to falls, the risk can be highest with strong opioids, as well as dose dependent.

Authors of the review noted that pain and opioid use should be assessed regularly to reduce the risk of falls and if clinical conditions allow deprescribing, changing to a lower dose, or safer alternative should be considered.

“Weighing the risks and benefits is necessary before prescribing opioids, especially to older persons at high risk of falls,” concluded researchers. “Clinical decision tools assist prescribers in clinical decisions regarding deprescribing.”

Reference:
Virnes RE, Tiihonen M, Karttunen N, van Poelgeest EP, van der Velde N, Hartikainen S. Opioids and falls risk in older adults: a narrative review. Drugs Aging. Published online March 15, 2022. doi:10.1007/s40266-022-00929-y