Falls are a major problem for older people. New research from UNSW Medicine & Health examines whether opioid prescribing decisions could reduce their risk.
New research from UNSW Sydney's School of Population Health has found that older people prescribed long-acting tapentadol had fewer serious falls than those prescribed a similar form of oxycodone.
The study, published in PLOS Medicine, analysed health data from more than 207,000 patients. The findings could help doctors consider fall risks when prescribing opioids for pain relief, especially for patients over the age of 65.
“Falls can be a serious problem for older people,” said Ximena Camacho lead author and PhD candidate, UNSW Medicine & Health.
“The latest data suggests that every day 17 Australians die and 400 are hospitalised from falls, which is why uncovering potential risk factors is vital.”
“We also know from previous research that prescription opioids are associated with increased risk of falls, particularly in the first month of use.
"But this is the first time real-world data has directly compared the risk of falls in relation to the two most prescribed opioids in Australia.”
The researchers found a considerable difference in risk profile between sustained-release tapentadol and controlled-release oxycodone.
Compared to oxycodone, tapentadol was associated with a 40% lower risk of serious falls within the first 14 days of treatment and a 30% lower risk within 28 days.
People starting long-acting tapentadol experienced one to two fewer serious falls per 1,000 patients. Serious falls included those resulting in hospital admission, an emergency department visit or death.
The most prominent difference was in people over the age of 80 who had not recently taken opioids. This group experienced six to 10 fewer falls per 1,000 patients.
The researchers noted the differences in how the drugs affect the central nervous system could help explain the findings.
"Previous clinical trials have found that oxycodone seems to cause more dizziness and drowsiness than tapentadol – offering one possible explanation for its higher fall risk – but more research is needed to validate this hypothesis,” said Professor Sallie Pearson, Head of the Medicines Intelligence Research Program, UNSW Medicine & Health.
The researchers cautioned against interpreting their research as a general recommendation to prescribe tapentadol over oxycodone. Fall risk is only one factor doctors consider when choosing what opioid to prescribe.
But given the potentially life-threatening impact of falls in older people, it’s an important variable for medical practitioners and patients to be aware of when considering which opioid-based pain relief is the most appropriate for each individual’s circumstances.