title: Risk of injury associated with opioid use in older adults.
abstract: OBJECTIVE
  To estimate the dose-related risk of injuries in older adults associated with the use of low-, medium-, and high-potency opioids.
  
  
  METHODS
  Historical population-based cohort study: 2001 to 2003.
  
  
  METHODS
  Quebec, Canada's, universal healthcare system.
  
  
  METHODS
  Four hundred three thousand three hundred thirty-nine adults aged 65 and older.
  
  
  METHODS
  Population-based health databases were used to measure preexisting risk factors for injuries in 2001/02 and drug use and injuries during follow-up (2003). Type and dose of opioids were measured as time-dependent variables, as were other drugs that may increase the risk of injury from sedating side-effects or hypotension. The risk of injury per one adult dose increase in opioid dose was estimated using multivariate Cox proportional hazards models.
  
  
  RESULTS
  During the follow-up year, 50.7% of the study population were prescribed drugs with sedating side effects, 15.3% were prescribed an opioid, 20.7% were concurrently using more than one sedating medication, and 3.7% were treated for an injury, fractures (55.1%) being the most common. After adjusting for concurrent drug use and baseline risk factors, low- (hazard ratio (HR)=1.36, 95% confidence interval (CI)=1.33-1.39) and intermediate-potency (HR=1.05, 95% CI=1.02-1.07) opioids were associated with the risk of injury. Use of codeine combinations was associated with the highest risk of injury, a 127% greater risk (HR=2.27, 95% CI=2.21-2.34) per one adult dose increase. (The mean World Health Organization standardized dose in the study population was 1.71 ± 0.85 adult doses.)
  
  
  CONCLUSIONS
  Opioids increase the risk of injury in older adults, particularly codeine combinations.
authors.affiliation: Department of Epidemiology and Biostatistics, McGill University, Montreal Quebec, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Buckeridge
authors.forename: Allen
authors.initials: A
authors.lastname: Huang
authors.forename: James
authors.initials: J
authors.lastname: Hanley
authors.forename: Armel
authors.initials: A
authors.lastname: Kelome
authors.forename: Kristen
authors.initials: K
authors.lastname: Reidel
authors.forename: Aman
authors.initials: A
authors.lastname: Verma
authors.forename: Nancy
authors.initials: N
authors.lastname: Winslade
authors.forename: Robyn
authors.initials: R
authors.lastname: Tamblyn
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D016292:Procedural Sedation / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D010166:Palliative Care / Q000379:methods*; D011379:Prognosis; D016016:Proportional Hazards Models; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000209:etiology
chemical_list: D000701:Analgesics, Opioid