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Related Experiment Video

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Using a Real-Time Locating System to Measure Walking Activity Associated with Wandering Behaviors Among Institutionalized Older Adults
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Association between Opioid-Benzodiazepine Trajectories and Injurious Fall Risk among US Medicare Beneficiaries.

Grace Hsin-Min Wang1, Juan M Hincapie-Castillo2,3, Walid F Gellad4,5,6

  • 1Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA.

Journal of Clinical Medicine
|June 27, 2024
PubMed
Summary

Concurrent opioid and benzodiazepine use increases injurious fall risk in older adults. Specific dosing patterns, not just use, significantly elevate this risk, emphasizing personalized risk assessment.

Keywords:
benzodiazepinefallsfracturesopioidtrajectory

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Area of Science:

  • Gerontology
  • Pharmacology
  • Public Health

Background:

  • Concurrent opioid (OPI) and benzodiazepine (BZD) use may increase injurious fall risk.
  • Patients often require concurrent OPI-BZD for co-occurring pain and anxiety.
  • Understanding longitudinal OPI-BZD dosing patterns is crucial for fall risk assessment.

Purpose of the Study:

  • To examine the association between longitudinal OPI-BZD dosing patterns and subsequent injurious fall risk.
  • To identify specific OPI-BZD trajectories associated with increased fall risk.
  • To inform clinical practice regarding the safe use of OPIs and BZDs in older adults.

Main Methods:

  • Retrospective cohort study of Medicare beneficiaries initiating OPI and/or BZD (2016-2018).
  • Group-based multi-trajectory models identified 13 distinct OPI-BZD use patterns over 3 months.
  • Inverse-probability-of-treatment-weighted Cox proportional hazards models estimated injurious fall risk.

Main Results:

  • 13 OPI-BZD trajectories were identified among 622,588 beneficiaries.
  • Six trajectories showed significantly increased 3-month injurious fall risk compared to very-low OPI-only use.
  • Specific trajectories with higher risk included late discontinuation of very-low OPI, gradual decline of low OPI, rapid decline of moderate OPI, stable low BZD, stable very-low OPI/low BZD, and gradual decline of low OPI/low BZD.

Conclusions:

  • Injurious fall risk varies significantly across different longitudinal opioid and benzodiazepine dosing patterns.
  • The duration and dosage of OPI-BZD use are critical factors in assessing fall risk.
  • Personalized risk assessment considering specific OPI-BZD trajectories is essential for older adults.