Risk of Injury Associated with Skeletal Muscle Relaxant Use in Older Adults

Author:

Spence Michele M1,Shin Patrick J2,Lee Eric A3,Gibbs Nancy E4

Affiliation:

1. Michele M Spence PhD, Clinical Pharmacy Research Scientist, Pharmacy Outcomes Research Group, Kaiser Permanente, Downey, CA

2. Patrick J Shin PharmD, Clinical Pharmacist, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA

3. Eric A Lee MD, Assistant Chief, Department of Internal Medicine, Kaiser Permanente West Los Angeles Medical Center, Los Angeles; Co-Chair, High-Risk Drugs in the Elderly, Kaiser Permanente Southern California Region

4. Nancy E Gibbs MD, Physician in Charge of Geriatric Services, Department of Family Practice, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, CA; Co-Chair, High-Risk Drugs in the Elderly, Kaiser Permanente Southern California Region

Abstract

BACKGROUND The use of skeletal muscle relaxants (SMRs) among older adults is associated with sedation and confusion, which may lead to an increased risk of falls and injuries. SMRs continue to be used among older adults, although they are on the Beers list as drugs to avoid in the elderly. OBJECTIVE To investigate the relationship between SMR use and subsequent risk of injury. METHODS This was a retrospective case-control study of members aged 65 years or older enrolled in an integrated health care system. Cases were defined as patients with a documented injury resulting in either a hospitalization or an emergency department or urgent care visit from January 2009 through December 2010. Cases were matched to controls in a 1:4 ratio by age and sex. Patients had to be enrolled and alive on the date of an injury (index date). SMR exposure for all cases and controls was evaluated within 60 days prior to the index date. Conditional logistic regression adjusted for covariates was performed, with risk estimates presented as odds ratios with 95% confidence intervals. RESULTS From a base population of 322,806 older adults, we identified 27,974 cases of injury and 104,303 matched controls. Among the cases, 365 (1.30%) used an SMR; among the controls, 801 (0.77%) used an SMR in the 60 days prior to the index date. After adjustment for demographic and clinical covariates, risk of injury was significantly increased for patients using an SMR compared to no use (OR 1.32, 95% CI 1.16–1.50; p < 0.001). Carisoprodol was associated with an increased risk of injury (OR 1.73, 95% CI 1.04–2.88; p = 0.036), as were methocarbamol (OR 1.42, 95% CI 1.16–1.75; p = 0.001) and cyclobenzaprine (OR 1.22, 95% CI 1.02–1.45; p = 0.029). CONCLUSIONS Older adults using SMRs have an increased risk of injury. These findings provide evidence to support current recommendations to avoid the use of SMRs in elderly patients.

Publisher

SAGE Publications

Subject

Pharmacology (medical)

Reference20 articles.

Cited by 42 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3