Format

Send to

Choose Destination
J Gerontol A Biol Sci Med Sci. 2019 Nov 22. pii: glz270. doi: 10.1093/gerona/glz270. [Epub ahead of print]

Medications acting on the central nervous system and fall-related injuries in community dwelling older adults: a new user cohort study.

Author information

1
Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA.
2
Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA.
3
Comagine Health, Seattle, WA (was at the School of Pharmacy, University of Washington, Seattle, WA when work was completed).
4
Department of Medicine, Division of General Internal Medicine, University of Washington, Seattle.

Abstract

BACKGROUND:

It is well established that individual medications that affect the central nervous system (CNS) increase falls risk in older adults. However, less is known about risks associated with taking multiple CNS-active medications.

METHODS:

Employing a new user design, we used data from the Adult Changes in Thought study, a prospective cohort of community-dwelling people aged 65 and older without dementia. We created a time-varying composite measure of CNS-active medication exposure from electronic pharmacy fill data and categorized into mutually exclusive categories: current (within prior 30 days), recent (31-90 days), past (91-365 days), or non-use (no exposure in prior year). We calculated standardized daily dose and identified new initiation. Cox proportional hazards models examined the associations between exposures and the outcome of fall-related injury identified from health plan electronic databases.

RESULTS:

2,595 people had 624 fall-related injuries over 15,531 person-years of follow-up. KEYWORDS (not in title): Relative to non-use, fall-related injury risk was significantly greater for current use of CNS-active medication (HR 1.95; 95% CI 1.57-2.42), but not for recent or past use. Among current users, increased risk was noted with all doses. Risk was increased for new initiation compared with no current use (HR 2.81; 95% CI 2.09-3.78). Post-hoc analyses revealed that risk was especially elevated with new initiation of opioids.

CONCLUSION:

We found that current use, especially new initiation, of CNS-active medications was associated with fall-related injury in community-dwelling older adults. Increased risk was noted with all dose categories. Risk was particularly increased with new initiation of opioids.

KEYWORDS:

drug related; epidemiology; falls

PMID:
31755896
DOI:
10.1093/gerona/glz270

Supplemental Content

Full text links

Icon for Silverchair Information Systems
Loading ...
Support Center