Prescription characteristics associated with fall-related injury risk among older adults prescribed benzodiazepines: a cohort study
Abstract Background Benzodiazepines (BZD) are widely prescribed to older adults despite their association with increased fall injury. Our aim is to better characterize risk-elevating factors among those prescribed BZD. Methods A retrospective cohort study using a 20% sample of Medicare beneficiarie...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-10-01
|
| Series: | BMC Geriatrics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12877-022-03497-3 |
| _version_ | 1797991714861875200 |
|---|---|
| author | Donovan T. Maust Amy S. B. Bohnert Julie Strominger Neil Alexander Lillian Min Geoffrey J. Hoffman Jason E. Goldstick |
| author_facet | Donovan T. Maust Amy S. B. Bohnert Julie Strominger Neil Alexander Lillian Min Geoffrey J. Hoffman Jason E. Goldstick |
| author_sort | Donovan T. Maust |
| collection | DOAJ |
| description | Abstract Background Benzodiazepines (BZD) are widely prescribed to older adults despite their association with increased fall injury. Our aim is to better characterize risk-elevating factors among those prescribed BZD. Methods A retrospective cohort study using a 20% sample of Medicare beneficiaries with Part D prescription drug coverage. Patients with a BZD prescription (“index”) between 1 April 2016 and 31 December 2017 contributed to incident (n=379,273) and continuing (n=509,634) cohorts based on prescriptions during a 6-month pre-index baseline. Exposures were index BZD average daily dose and days prescribed; baseline BZD medication possession ratio (MPR) (for the continuing cohort); and co-prescribed central nervous system-active medications. Outcome was a treated fall-related injury within 30 days post-index BZD, examined using Cox proportional hazards adjusting for demographic and clinical covariates and the dose prescribed. Results Among incident and continuing cohorts, 0.9% and 0.7% experienced fall injury within 30 days of index. In both cohorts, injury risk was elevated immediately post-index among those prescribed the lowest quantity: e.g., for <14-day fill (ref: 14-30 days) in the incident cohort, risk was 37% higher the 10 days post-fill (adjusted hazard ratio [HR] 1.37 [95% confidence interval [CI] 1.19-1.59]). Risk was elevated immediately post-index for continuing users with low baseline BZD exposure (e.g., for MPR <0.5 [ref: MPR 0.5-1], HR during days 1-10 was 1.23 [CI 1.08-1.39]). Concurrent antipsychotics and opioids were associated with elevated injury risk in both cohorts (e.g., incident HRs 1.21 [CI 1.03-1.40] and 1.22 [CI 1.07-1.40], respectively; continuing HRs 1.23 [1.10-1.37] and 1.21 [1.11-1.33]). Conclusions Low baseline BZD exposure and a small index prescription were associated with higher fall injury risk immediately after a BZD fill. Concurrent exposure to antipsychotics and opioids were associated with elevated short-term risk for both incident and continuing cohorts. |
| first_indexed | 2024-04-11T08:56:44Z |
| format | Article |
| id | doaj.art-ca8773fa88ab47e3ac3a1d0637e6a22c |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-04-11T08:56:44Z |
| publishDate | 2022-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj.art-ca8773fa88ab47e3ac3a1d0637e6a22c2022-12-22T04:33:17ZengBMCBMC Geriatrics1471-23182022-10-0122111010.1186/s12877-022-03497-3Prescription characteristics associated with fall-related injury risk among older adults prescribed benzodiazepines: a cohort studyDonovan T. Maust0Amy S. B. Bohnert1Julie Strominger2Neil Alexander3Lillian Min4Geoffrey J. Hoffman5Jason E. Goldstick6Injury Prevention Center, University of MichiganInjury Prevention Center, University of MichiganCenter for Clinical Management Research, VA Ann Arbor Healthcare SystemInjury Prevention Center, University of MichiganDepartment of Internal Medicine, University of Michigan Medical SchoolUniversity of Michigan School of NursingInjury Prevention Center, University of MichiganAbstract Background Benzodiazepines (BZD) are widely prescribed to older adults despite their association with increased fall injury. Our aim is to better characterize risk-elevating factors among those prescribed BZD. Methods A retrospective cohort study using a 20% sample of Medicare beneficiaries with Part D prescription drug coverage. Patients with a BZD prescription (“index”) between 1 April 2016 and 31 December 2017 contributed to incident (n=379,273) and continuing (n=509,634) cohorts based on prescriptions during a 6-month pre-index baseline. Exposures were index BZD average daily dose and days prescribed; baseline BZD medication possession ratio (MPR) (for the continuing cohort); and co-prescribed central nervous system-active medications. Outcome was a treated fall-related injury within 30 days post-index BZD, examined using Cox proportional hazards adjusting for demographic and clinical covariates and the dose prescribed. Results Among incident and continuing cohorts, 0.9% and 0.7% experienced fall injury within 30 days of index. In both cohorts, injury risk was elevated immediately post-index among those prescribed the lowest quantity: e.g., for <14-day fill (ref: 14-30 days) in the incident cohort, risk was 37% higher the 10 days post-fill (adjusted hazard ratio [HR] 1.37 [95% confidence interval [CI] 1.19-1.59]). Risk was elevated immediately post-index for continuing users with low baseline BZD exposure (e.g., for MPR <0.5 [ref: MPR 0.5-1], HR during days 1-10 was 1.23 [CI 1.08-1.39]). Concurrent antipsychotics and opioids were associated with elevated injury risk in both cohorts (e.g., incident HRs 1.21 [CI 1.03-1.40] and 1.22 [CI 1.07-1.40], respectively; continuing HRs 1.23 [1.10-1.37] and 1.21 [1.11-1.33]). Conclusions Low baseline BZD exposure and a small index prescription were associated with higher fall injury risk immediately after a BZD fill. Concurrent exposure to antipsychotics and opioids were associated with elevated short-term risk for both incident and continuing cohorts.https://doi.org/10.1186/s12877-022-03497-3MedicationHip fractureEpidemiology |
| spellingShingle | Donovan T. Maust Amy S. B. Bohnert Julie Strominger Neil Alexander Lillian Min Geoffrey J. Hoffman Jason E. Goldstick Prescription characteristics associated with fall-related injury risk among older adults prescribed benzodiazepines: a cohort study BMC Geriatrics Medication Hip fracture Epidemiology |
| title | Prescription characteristics associated with fall-related injury risk among older adults prescribed benzodiazepines: a cohort study |
| title_full | Prescription characteristics associated with fall-related injury risk among older adults prescribed benzodiazepines: a cohort study |
| title_fullStr | Prescription characteristics associated with fall-related injury risk among older adults prescribed benzodiazepines: a cohort study |
| title_full_unstemmed | Prescription characteristics associated with fall-related injury risk among older adults prescribed benzodiazepines: a cohort study |
| title_short | Prescription characteristics associated with fall-related injury risk among older adults prescribed benzodiazepines: a cohort study |
| title_sort | prescription characteristics associated with fall related injury risk among older adults prescribed benzodiazepines a cohort study |
| topic | Medication Hip fracture Epidemiology |
| url | https://doi.org/10.1186/s12877-022-03497-3 |
| work_keys_str_mv | AT donovantmaust prescriptioncharacteristicsassociatedwithfallrelatedinjuryriskamongolderadultsprescribedbenzodiazepinesacohortstudy AT amysbbohnert prescriptioncharacteristicsassociatedwithfallrelatedinjuryriskamongolderadultsprescribedbenzodiazepinesacohortstudy AT juliestrominger prescriptioncharacteristicsassociatedwithfallrelatedinjuryriskamongolderadultsprescribedbenzodiazepinesacohortstudy AT neilalexander prescriptioncharacteristicsassociatedwithfallrelatedinjuryriskamongolderadultsprescribedbenzodiazepinesacohortstudy AT lillianmin prescriptioncharacteristicsassociatedwithfallrelatedinjuryriskamongolderadultsprescribedbenzodiazepinesacohortstudy AT geoffreyjhoffman prescriptioncharacteristicsassociatedwithfallrelatedinjuryriskamongolderadultsprescribedbenzodiazepinesacohortstudy AT jasonegoldstick prescriptioncharacteristicsassociatedwithfallrelatedinjuryriskamongolderadultsprescribedbenzodiazepinesacohortstudy |