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Opioids & Falls Is there a connection?

Opioids & Falls Is there a connection?. Leah Tobey, PT, DPT, cert D.N. UAMS Outpatient Rehabilitation-Spine Center. Objectives. How to join Poll Everywhere questions:. To: 22333 Send the text: LEAHTOBEY999. Fall Facts. FOF (fear of falling) can contribute

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Opioids & Falls Is there a connection?

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  1. Opioids & Falls Is there a connection? Leah Tobey, PT, DPT, cert D.N. UAMS Outpatient Rehabilitation-Spine Center

  2. Objectives

  3. How to join Poll Everywhere questions: To: 22333 Send the text: LEAHTOBEY999

  4. Fall Facts • FOF (fear of falling) can contribute • A majority of falls occur during routine activities • Falls usually are not caused by just one issue • A large portion of falls are preventable • Being inactive results in loss of muscle strength and balance. • Social interaction can be compromised & increase the risk for isolation, depression, and anxiety A Matter of Balance, Volunteer Lay Leader Model. Evidence-Based Falls Management Program for Older Adults www.mainehealth.org/pfha

  5. Common reasons & risk factors • Common RFs (according to JAMA 2010 “The Patient Who Falls” by Tinetti& Kumar): • Previous falls • Strength • Gait • Balance impairments • Medications • Study found 3 effective single interventions: • Physical Therapy • Cataract surgery • Medication reduction Tinetti ME, Kumar C. The patient who falls: "It's always a trade-off". JAMA. 2010;303(3):258–266. doi:10.1001/jama.2009.2024

  6. Opioids & Falls in the older adult • Opioid Epidemic • 1 in 4 adults use psychoactive medications with abuse potential • By 2020 estimated 5 million older adults will have substance abuse problems • Falls • Older adults taking opioids are 4-5 times more likely to fall than those taking NSAIDS • Older adults are highly susceptible to cognitive & psychomotor changes/effects from opioids • Physiological changes with aging impacts medication effects • Impaired renal function; Increased half-life; decreased metabolism Pfortmueller CA, Lindner G, Exadaktylos K. Reducing Fall Risks in the Elderly: risk factors and fall prevention, a systematic review. Minerva Med. 2014; 105: 275-81. Henderson, AW, Davita M, et al. Prescription opioid use and misuse among older adult Rhode Island Hospital emergency department patients. Rhode Island Medical Journal, March 2015, 28-31.

  7. Opioids & falls continued. • Physiological changes with aging impacts medication effects • Impaired renal function; Increased half-life; decreased metabolism • Opioid side effects among geriatrics • Falls, fractures, cognitive decline, urinary retention, & suicide • Changes of aging • Vision, depth perception, sarcopenia, loss of mm mass, increased frailty Pfortmueller CA, Lindner G, Exadaktylos K. Reducing Fall Risks in the Elderly: risk factors and fall prevention, a systematic review. Minerva Med. 2014; 105: 275-81. Henderson, AW, Davita M, et al. Prescription opiod use and misuse among older adult Rhode Island Hospital emergency department patients. Rhode Island Medical Journal, March 2015, 28-31.

  8. JAMA, 2009 publication • Chronic pain is a major contributor to disability in older adults • The potential role of chronic pain as a RF for falls is poorly understood • Objective: determine whether chronic, MSK pain is associated with an increased occurrence of falls in a cohort of community-living older adults • Participants recorded falls on monthly calendar postcards mailed to the study center (Beth Israel Deaconess Medical Center in Boston, MA) • 4,319 70 y/o resided in the sampled addresses • 749 adults 70 years old included in study (completed baseline home interview & clinical exam) • 1,029 falls reported during the follow-up period of 18 months

  9. Highest fall risk was observed in persons with 2 or more pain sites and those in highest tertiles (pt reported pain) of pain severity

  10. Results & Discussion • Chronic pain measured according to # of locations, severity, or pain interference with daily activities was associated with greater risk of falls in older adults. • More than half (55%) fell at least once during follow-up period • MSK pain in 2 or more locations at baseline was positively associated with greater occurrence of falls • Reported by 300/749 participants • More severe/disabling pain was associated with higher fall rates

  11. Discussion continued.Pain-falls relationship Underlying mechanics for pain-falls relationship (3 categories): • 1. Local joint pathology • 2. Neuromuscular effects of pain • 3. Central mechanisms whereby pain interferes with cognition or executive function

  12. JAMA, 2019 publication Number of deaths from falls among US adults aged 75 years or older increased from 8,613 in 2000 to 25,189 in 2016 June 4, 2019 Hartholt KA, Lee R, Burns ER, van Beeck EF. Mortality From Falls Among US Adults Aged 75 Years or Older, 2000-2016. JAMA. 2019;321(21):2131–2133. doi:10.1001/jama.2019.4185 https://jamanetwork.com/journals/jama/fullarticle/2735063?guestAccessKey=df56bbcc-17ca-47b0-986f-77bf6d03962e&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=060419 Mortality From Falls Among US Adults Aged 75 Years or Older, 2000-2016 Age-adjusted mortality rates among adults aged 75 years or older increased significantly from 60.7 (95% CI, 58.8-62.7) per 100 000 men in 2000 to 116.4 (95% CI, 113.7-119.1) per 100 000 men in 2016 &from 46.3 (95% CI, 45.0-47.6) per 100 000 women in 2000 to 105.9 (95% CI, 103.9-107.8) per 100 000 women in 2016

  13. Fall Prevention Screening

  14. STEADI Initiative • Developed by Centers for Disease Control & Prevention • “Stopping Elderly Accidents, Deaths, and Injuries” • Mission: To help health care providers implement fall prevention • Specific focus: reducing falls among community-dwelling older adults • STEADI Initiative: free tools and resources needed to manage older adult’s fall risk • www.cdc.gov/steadi/materials.html

  15. Screening option • The Potential to Reduce Falls and Avert Costs by Clinically Managing Fall Risk • AJPM American Journal of Preventative Medicine Vol 55, September 2018, Pg 290-297 • https://www.sciencedirect.com/science/article/pii/S0749379718317598?via%3Dihub#t0005

  16. STEADI initiative continued Encourages providers to take the following 3 initial steps to begin addressing their patients' fall risks related to medications: Screen to identify patients at risk for a fall Review and manage medications Recommend vitamin D supplementation to improve bone, muscle, and nerve health CDC pocket guide https://www.cdc.gov/steadi/pdf/STEADI-PocketGuide-508.pdf

  17. Evidenced-based fall prevention classes MOB: Matter of Balance Program @ UAMS • The program’s goal is to reduce fear of falling, stop the fear of falling cycle, and increase activity levels among community-dwelling older adults • Coping strategies and skills • UAMS Arkansas Geriatric Education Collaborative • Website: www.agec.uams.eduPhone: 501-603-1965Email: agec@uams.edu Target population: • 60 or older, ambulatory, able to problem-solve • Concerned about falls • Interested in improving flexibility, balance, and strength Essential program components and activities:Group discussion, Problem-solving, Skill building, Assertiveness training, & Exercise training Sharing practical solutions: • Cognitive restructuring—learning to shift from negative to positive thinking patterns or thinking about something in a different way • Length/Timeframe of program = Eight two-hour sessions

  18. Additional research discussion… “Pain and pain killers: the falls tradeoff.” • The BMJ (2016) reviewed falls prevention in community dwelling older people. • Pain (IE: lower limp or foot pain) as a RF for falls. • Opioids are a falls RF because of their sedative effect • The use of >3 drugs are a RF for falls • Take home point? • Vieira & colleagues suggest a “systematic assessment and management of pain.” Vieira E, Palmer R, Chaves P. Prevention of falls in older people living in the community. BMJ 2016;:i1419. doi:10.1136/bmj.i1419

  19. Case Conference and Feedback Continuing Education Credit TEXT: 501-406-0076 Event ID: 31558-24581

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