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Citation
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Gray SL, Marcum ZA, Dublin S, Walker R, Golchin N, Rosenberg DE, Bowles EJ, Crane P, Larson EB. J. Gerontol. A Biol. Sci. Med. Sci. 2019; ePub(ePub): ePub. |
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Abstract
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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.
© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
Language: en |