Association of Average Daily Morphine Milligram Equivalents and Falls in Older Adult Chronic Opioids Users

Background: Opioids pose medication-related adverse effects, including falls. Falls are the leading cause of fatal and nonfatal injuries in older adults. Though opioids are not generally recommended in older adults, they are still commonly prescribed. Limited research exists regarding the total daily dose of opioids and risk of falls in older adults. Objective: To determine the association of the total daily dose of opioids and the occurrence of falls in older adults. Design: Retrospective, multicenter, community-based cohort study. Subjects: Older adults receiving chronic opioids seen in any of ten outpatient clinics. Measures: Data from electronic health records was used to determine the association of daily morphine milligram equivalents (MMEs) with falls in older adults. The summation of scheduled and breakthrough MMEs from prescription orders over a 1-year look-back period was used to calculate MMEs. The primary outcome was fall history in that same year based on patient self-report. A receiver operating characteristic (ROC) curve was used to identify a threshold of average daily MMEs to predict an increase in fall risk. Results: A total of 762 patients were included, with the majority being white females and approximately 75 years old. Based on ROC analyses, the threshold where fall risk increased was 37 MMEs (p=0.07). Conclusion: For older adults, being prescribed more than 37 MMEs per day may be the point at which risk of falls increases significantly.Doctor of Pharmac