Center for Population Health and Aging, School of Public Health, Texas A&M University, College Station, TX, USA.
Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, USA.
Age Ageing. 2021 Sep 11;50(5):1578-1585. doi: 10.1093/ageing/afab051.
Persons living with dementia have an elevated risk of falling and chronic pain. This study investigates the relationship of pain medication use with falls among community-dwelling adults based on their cognitive status.
We analysed a nationally representative sample of community-dwelling Medicare beneficiaries (n = 7,491) who completed cognitive assessments used for dementia classification in the 2015 US National Health and Aging Trends Study. We performed survey-weighted logistic regression to investigate differential associations between pain medication use and a recent fall by cognitive status: no dementia, possible dementia and probable dementia, controlling for sociodemographic and health characteristics.
About 16.5% of the analytic sample was classified as possible dementia (8.3%) and probable dementia (8.2%). Pain medication use was associated with a recent fall among those with probable dementia [odds ratio (OR) = 1.86, 95% confidence interval (CI): 1.14, 3.03], controlling for sociodemographic and health characteristics. Taking medication for pain 2 days a week or more (OR = 2.14, 95% CI: 1.20, 3.81) was associated with falls among those with probable dementia. Bothersome pain and worry about falling down were also associated with falls among participants with no dementia and possible dementia, respectively.
Differential risk factors for falls by cognitive status imply the need for tailored pain management and fall prevention strategies. The provision of fall prevention programmes stressing balance training and medication use is important regardless of cognitive status in community-dwelling older adults. Future research should explore other modifiable factors associated with the risk of falls among community-dwelling adults.
痴呆症患者跌倒和慢性疼痛的风险较高。本研究根据认知状态，调查了社区居住的成年人中疼痛药物使用与跌倒之间的关系。
我们分析了 2015 年美国国家健康老龄化趋势研究中完成用于痴呆分类的认知评估的具有代表性的社区居住的医疗保险受益人（n=7491）的全国代表性样本。我们进行了调查加权逻辑回归分析，以根据认知状态调查疼痛药物使用与最近跌倒之间的差异关联：无痴呆、可能痴呆和可能痴呆，同时控制社会人口统计学和健康特征。
分析样本中约有 16.5%被归类为可能痴呆（8.3%）和可能痴呆（8.2%）。在可能痴呆症患者中，疼痛药物使用与最近跌倒有关（比值比[OR] = 1.86，95%置信区间[CI]：1.14，3.03），同时控制了社会人口统计学和健康特征。每周服用药物治疗疼痛 2 天或更多（OR=2.14，95%CI：1.20，3.81）与可能痴呆症患者的跌倒有关。令人烦恼的疼痛和担心跌倒也分别与无痴呆症和可能痴呆症患者的跌倒有关。
认知状态与跌倒风险的差异因素意味着需要量身定制疼痛管理和跌倒预防策略。在社区居住的老年人中，无论认知状态如何，提供强调平衡训练和药物使用的跌倒预防计划都很重要。未来的研究应该探索与社区居住成年人跌倒风险相关的其他可改变因素。
