Differential risk of falls associated with pain medication among community-dwelling older adults by cognitive status

Background: Persons living with dementia have an elevated risk of falling and chronic pain. This study investigates the relationship of pain medication use with falls among community-dwelling adults based on their cognitive status. Methods: We analysed a nationally representative sample of community-dwelling Medicare beneficiaries (n=7,491) who completed cognitive assessments used for dementia classification in the 2015 US National Health and Aging Trends Study. We performed survey-weighted logistic regression to investigate differential associations between pain medication use and a recent fall by cognitive status: No dementia, possible dementia and probable dementia, controlling for sociodemographic and health characteristics. Results: About 16.5% of the analytic sample was classified as possible dementia (8.3%) and probable dementia (8.2%). Pain medication use was associated with a recent fall among those with probable dementia [odds ratio (OR)=1.86, 95% confidence interval (CI): 1.14, 3.03], controlling for sociodemographic and health characteristics. Taking medication for pain 2 days a week or more (OR=2.14, 95% CI: 1.20, 3.81) was associated with falls among those with probable dementia. Bothersome pain and worry about falling down were also associated with falls among participants with no dementia and possible dementia, respectively. Conclusion: Differential risk factors for falls by cognitive status imply the need for tailored pain management and fall prevention strategies. The provision of fall prevention programmes stressing balance training and medication use is important regardless of cognitive status in community-dwelling older adults. Future research should explore other modifiable factors associated with the risk of falls among community-dwelling adults.