Opioid Use and the Risk of Falls, Fall-related Fractures and Other Injuries among Older Adults: A Systematic Review and Meta-Analysis
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Background: There is increasing concern about opioid use as a pain treatment option among older adults. Existing literature implies an association between opioid use and fracture, leading to increased risk of death and disabilities among older adults; yet this relationship has not been fully explored. We performed a meta-analysis to evaluate the associations between opioid use and adverse health outcomes including falls, fall-related fractures and other injuries. Methods: A systematic literature search from onset to November 2018 was conducted using electronic databases (MEDLINE, EMBASE, CINAHL and PsycINFO). We computed pooled risk estimates by effect size measure: relative risk (RR), odds ratio (OR), and hazards ratio (HR). The random-effects model was applied to calculate the pooled risk estimates due to heterogeneity. Subgroup analyses explored differences in risk estimates by outcome measure. Results: Twenty-four studies, involving 136,747 participants, met the inclusion criteria for this meta-analysis. Overall, opioid use was significantly associated with risk outcomes (OR = 1.88, 95% CI = 1.59 - 2.24, I2 = 95.4 %). In subgroup analyses, risk estimates for the three outcomes were consistent, with OR ranging from 1.70 to 2.20. Conclusions: While heterogeneity is present, results suggest an increased risk of falls, fall injuries and fractures among older adults who used opioids. Findings highlight the need for opioid education and pain management interventions among older adults to offset fall-related risk. Further research is needed about opioid use duration and dosage among high-risk older populations. Additionally, prospective studies and adjustment of confounding bias are encouraged.
