Risk of Injury Associated With Opioid Use in Older Adults

J Am Geriatr Soc. 2010 Sep;58(9):1664-70. doi: 10.1111/j.1532-5415.2010.03015.x.


Objectives: To estimate the dose-related risk of injuries in older adults associated with the use of low-, medium-, and high-potency opioids.

Design: Historical population-based cohort study: 2001 to 2003.

Setting: Quebec, Canada's, universal healthcare system.

Participants: Four hundred three thousand three hundred thirty-nine adults aged 65 and older.

Measurements: 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.)

Conclusion: Opioids increase the risk of injury in older adults, particularly codeine combinations.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Analgesics, Opioid / administration & dosage
  • Analgesics, Opioid / adverse effects*
  • Conscious Sedation / adverse effects*
  • Dose-Response Relationship, Drug
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Male
  • Palliative Care / methods*
  • Prognosis
  • Proportional Hazards Models
  • Quebec / epidemiology
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Wounds and Injuries / epidemiology*
  • Wounds and Injuries / etiology


  • Analgesics, Opioid