University of Massachusetts Chan Medical School, Worcester, MA, USA.
Division of Injury Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, GA, USA.
Clin Toxicol (Phila). 2024 Oct;62(10):661-668. doi: 10.1080/15563650.2024.2400186. Epub 2024 Sep 28.
In 2020, there were 36.7 million reported falls among older adults (65+) in the United States. Ethanol and other sedating substances may increase fall risk among older adults due to their effect on cognitive and physical function. We estimate the prevalence of these substances in blood specimens of older adults presenting with a fall injury at selected trauma centers.
The initial study collected blood specimens from May 2020 through July 2021 from adults undergoing a trauma team evaluation at selected United States Level 1 trauma centers. We limited our study to older adults evaluated after a fall ( = 1,365) and selected a random sample ( = 300) based on age, sex, and trauma-center quotas. Medical health records and blood specimens obtained at trauma center presentation were analyzed. We estimated the prevalence of ethanol, benzodiazepines, cannabinoids, and opioids in the blood specimens. Two-sample tests of binomial proportions and Chi-square two-tailed tests were used to compare prevalence estimates of substances by demographic characteristics.
At least one substance was detected among 31.3% of samples analyzed. Prevalences of specific substances detected were 9.3% (95% CI: 6.0-12.6%) for benzodiazepines, 4.3% (95% CI: 2.0-6.7%) for cannabinoids, 8.0% (95% CI: 5.2-11.7%) for ethanol, and 15.0% (95% CI: 10.9-19.1%) for opioids. There were 18 deaths (6%; 95% CI: 3.6-9.3%). One-third of decedents had at least one substance detected in their blood.
Opioids were the most frequently detected substance, followed by benzodiazepines, ethanol, and cannabinoids. Substance use prevalence was not uniform across demographics, with differences observed by sex and age.
This study provides insight into the frequency of the presence of substances that may contribute to fall risk and serious injury among older adults. Screening older adults for substances that impair cognitive and physical function can enhance clinical fall prevention efforts.
2020 年，美国有 3670 万 65 岁以上老年人报告跌倒。乙醇和其他镇静物质可能会通过影响认知和身体功能增加老年人跌倒的风险。我们估计在选定的创伤中心因跌倒受伤就诊的老年患者血液样本中这些物质的流行率。
最初的研究从 2020 年 5 月到 2021 年 7 月，从美国一级创伤中心接受创伤小组评估的成年人收集血液样本。我们将研究仅限于跌倒后接受评估的老年人（n=1365），并根据年龄、性别和创伤中心配额选择随机样本（n=300）。分析创伤中心就诊时的医疗记录和血液样本。我们估计血液样本中乙醇、苯二氮䓬类、大麻素和阿片类物质的流行率。二项式比例的双样本检验和卡方双侧检验用于比较按人口统计学特征的物质流行率估计值。
在分析的 31.3%的样本中至少检测到一种物质。检测到的特定物质的流行率分别为苯二氮䓬类 9.3%（95%CI：6.0-12.6%）、大麻素 4.3%（95%CI：2.0-6.7%）、乙醇 8.0%（95%CI：5.2-11.7%）和阿片类药物 15.0%（95%CI：10.9-19.1%）。有 18 人死亡（6%；95%CI：3.6-9.3%）。三分之一的死者血液中至少有一种物质被检测到。
阿片类药物是最常检测到的物质，其次是苯二氮䓬类、乙醇和大麻素。按性别和年龄观察到不同，物质使用流行率在不同人群中并不均匀。
本研究提供了有关可能导致老年人跌倒风险和严重伤害的物质存在频率的信息。对认知和身体功能受损的老年人进行物质筛查可以增强临床跌倒预防工作。
