Center for Population Health and Aging, Texas A&M University, College Station.
Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station.
J Gerontol A Biol Sci Med Sci. 2020 Sep 25;75(10):1989-1995. doi: 10.1093/gerona/glaa038.
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, increasing the risk of death and disabilities; yet, this relationship with other fall-related outcomes has not been fully explored. We performed a meta-analysis to evaluate the associations between opioid use and adverse health outcomes of falls, fall injuries, and fractures among older adults.
A systematic literature search was conducted using nine databases: Medline, Embase, CINAHL, PsycInfo, Global Health, Northern Light Sciences Conference Abstracts, Cochrane CENTRAL, WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov. We log-transformed effect sizes (relative risk [RR], odds ratio [OR], and hazard ratio [HR]) to compute pooled risk estimates comparable across the studies. The random-effects model was applied to calculate the pooled risk estimates due to heterogeneity. Meta-regressions explored differences in risk estimates by analysis method, study design, setting, and study quality.
Thirty studies, providing 34 relevant effect sizes, met the inclusion criteria for this meta-analysis. Overall, opioid use was significantly associated with falls, fall injuries, and fractures, with effect sizes ranging from 0.15 to 0.71. In meta-regressions, no selected factors explained heterogeneity.
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 nonopioid-related pain management interventions among older adults to decrease fall-related risk.
老年人中阿片类药物作为疼痛治疗选择的使用越来越令人担忧。现有文献表明阿片类药物的使用与骨折之间存在关联，增加了死亡和残疾的风险；然而，这种与其他与跌倒相关的结果的关系尚未得到充分探讨。我们进行了一项荟萃分析，以评估阿片类药物的使用与老年人跌倒、跌倒损伤和骨折的不良健康结果之间的关系。
使用九个数据库进行了系统的文献检索：Medline、Embase、CINAHL、PsycInfo、Global Health、Northern Light Sciences Conference Abstracts、Cochrane CENTRAL、世界卫生组织国际临床试验注册平台和 ClinicalTrials.gov。我们将效应大小（相对风险 [RR]、比值比 [OR] 和风险比 [HR]）转换为对数，以计算可在研究之间进行比较的汇总风险估计值。由于异质性，应用随机效应模型计算汇总风险估计值。元回归探索了分析方法、研究设计、设置和研究质量差异对风险估计值的影响。
30 项研究提供了 34 个相关的效应大小，符合本荟萃分析的纳入标准。总体而言，阿片类药物的使用与跌倒、跌倒损伤和骨折显著相关，效应大小范围从 0.15 到 0.71。在元回归中，没有选择的因素可以解释异质性。
尽管存在异质性，但结果表明，使用阿片类药物的老年人跌倒、跌倒损伤和骨折的风险增加。研究结果强调需要对老年人进行阿片类药物教育和非阿片类药物相关疼痛管理干预，以降低与跌倒相关的风险。
