Assessing Fall Events in Geriatric Cancer Patients who are Prescribed an Opioid and/or Benzodiazepine

Date

2021

Authors

Bhachawat, Neal
Rasu, Rafia
Agbor, Walter

ORCID

0000-0002-4834-7834 (Bhachawat, Neal)

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Abstract

IRBexempt#2020-013. Purpose: Opioids & benzodiazepines are commonly used in cancer pain treatment however their sedating effects increase a patient's fall risk. BEERS criteria was established to reduce adverse events related to medication use in elderly population. Falls are a leading cause of death in the geriatric population and seniors with cancer confer an estimated 20%increased risk. Objectives:(1)identify the demographics of cancer patients age65+ who experienced a fall,(2)determine fall event trends based on patient-specific factors & medications (3)determine if BEERS criteria was followed. Methods: A cross-sectional study analyzing fall outcomes in cancer patients, age 65+, with analgesic medications used to manage acute/chronic pain. The population data was be compiled from the CDC National Ambulatory Medical Care Survey(NAMCS).Diagnosis was based on ICD9/10 and medication codes. Database findings based on sample of office visits. Results: In the NAMCS database between 2006–2017 was 276,166,738 (weighted freq.) cancer patient visits, age 65+ with 83.16%experiencing a fall. 194,560,411 were taking Benzodiazepine only.31,941,74 5were taking Opioids and 68% were prescribed a benzodiazepine as adjunct therapy. Fall incidence: Opioid group 84.6% (p=.03); Benzodiazepine alone 97.1% (p< .001); Benzodiazepine + opioid 93.2% (p< .001). Of the 83.16% of patients who experienced a fall, majority were white and female; 54% were age 75+; Types of cancers: prostate (12.3%), breast (7.3%), lung (5.2%), colorectal (4.5%) and others (70.7%). Fall incident peaked during 2012-2014 with 41.9% of falls occurring and declined to 8.3% during 2015-2017 (p< 0.001). Conclusion: The fall rates experienced by geriatric cancer patients taking opioids and/or benzodiazepines is far greater than the national average for the general geriatric population: 25%suffering a fall. In 2015 BEERS criteria and FDA advised against concurrent use of benzodiazepines + opioids. Our results indicate clinicians followed these changed guidelines, resulting in a decrease in fall events during data period 2015-2017 and illustrating the crucial role BEERS criteria plays in patient safety.

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