Older adults should be screened for fall risk when prescribed opioids but many clinics lack the time and staff to routinely performs the screening, according to research presented at the American Academy of Physician Associates (AAPA) national conference held May 20 to 24, 2023, in Nashville, Tennessee. The authors note significant gaps in older adults who are on chronic opioid therapy being screened for fall risk and that with proper screening the risk can be reduced.
Adults aged 50 years and over who are taking opioids are at greater risk for falling compared with patients the same age who are not using opioids. To study screening rates, the researchers included patients at 3 outpatient clinics in Utah: an internal medicine clinic, a geriatric medicine clinic, and a family medicine clinic, in their retrospective chart review. The study included patients who were at least 50 years of age and had been using opioids for a minimum of 3 months, excluding patients on palliative care.
Of the 125 total patients included in the study, 64% were aged 65 years or more (mean age, 69.02 years). Findings indicated that only 12 patients (9.6%) were assessed for fall risk. “We were somewhat surprised that the baseline screening rate was so low,” said Johanna Greenberg, MPAS, PA-C, lead author of the study.
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“I agree and also understood how [the baseline screening rate] could be so low,” said Joanne Rolls, MPAS, PA-C, coauthor of the study. “There are significant factors competing for attention and management in primary care… The study timeframe also came during the second half of the pandemic; these screenings may have taken less precedence than other concerns of the older patient” population.
Researchers noted that the 38 patients in the study who were using benzodiazepines concurrently with opioid therapy had a greater fall risk compared with patients who were not prescribed benzodiazepines.
Of the 12 patients screened for fall risk, clinicians found that 9 patients had high fall risk. Five of the patients who were screened were also using benzodiazepines, and 4 out of the 5 were at high fall risk according to the screening.
“Our findings suggested that this was a missed opportunity to screen for falls and provide fall prevention for those who scored high risk. We also learned that we don’t know the prevalence of fall risk in this specific population,” Ms Greenberg said.
These results have laid the groundwork for the clinics to set a goal of increasing the number of patients in this population screened for fall risk from 9.6% to 25%. The researchers indicated that barriers to achieving this goal are multifactorial and vary by clinic.
According to the researchers, causes for low screening rates may include lack of clear criteria on when to screen for fall risk, lack of available staff to conduct the screening, and not having enough time during a patient’s appointment to conduct fall screening.
“I suspect that many clinics have low rates of screening and unknown fall-risk prevalence and are not currently aware of it,” said Ms Rolls. “I would add that for other similar clinics, making sure that the clinics are taking advantage of any system level approaches to screening [assigning home questionnaires prior to visits, or using best practice alerts during the encounter for instance] to be able to capture their baseline prevalence” would be a win.
Half of the 12 patients in this study who had their fall risk assessed were screened at the geriatric clinic; this may be because geriatric clinicians are trained in screening for fall risk and geriatric clinics have the longest appointment times relative to internal medicine and family medicine clinics.
At the geriatric clinic, 6 of 23 eligible patients (26%) received screening, compared with 4 of 37 (10.8%) patients at the internal medicine clinic and 2 of 65 patients (3%) at the family medicine clinic.
Ms Greenberg indicated that she and her team are continuing to research fall risk in older adults using chronic opioid therapy, and plan to publish additional findings in the next year.
Visit Clinical Advisor’s meetings section for more coverage of AAPA 2023.
References
- Gerner A, Jan S, Snelson C, et. al. Assessing the frequency of fall risk screening in older adults on chronic opioid therapy in primary care. Presented at: AAPA national conference; May 20-24, 2023; Nashville, TN.
