Relationship of Ethanol, Cannabinoids, Benzodiazepines, and Opioids to Serious Injuries from Falls in Adults Aged 55 and older

Abstract

Background
Falls among adults aged 55 and older lead to significant morbidity and mortality. The contribution of alcohol and other sedating drugs (including benzodiazepines, cannabinoids, opioids, and ethanol) is difficult to quantitate in acute care environments due to inconsistent clinical practice.

Objectives
This goal of this study was to assess the effect of recent substance use on adverse clinical outcomes among adults aged 55+ undergoing trauma evaluation after a fall.

Methods
We conducted a retrospective observational study of adults (55+) evaluated at a Level 1 trauma center from May 2020 to July 2021. We paired archival data from the study site’s trauma registry and electronic health records (EHR) to toxicological analyses of each cohort member’s bio-banked blood sample for ethanol, benzodiazepines, cannabinoids, and opioids. Regression models were used to analyze the relationship between substance use and adverse outcomes, adjusting for injury severity score (ISS).

Results
Among 274 adults aged 55+, detection rates were 21.2% for opioids, 18.6% for ethanol, 13.9% for benzodiazepines, and 9.1% for cannabinoids. Injuries identified included 16.4% spinal fractures, 9.5% extremity fractures, 7.7% hip/thigh/pelvic fractures. Intracranial hemorrhages were more likely if the patient had been recently taking a benzodiazepine (aOR = 3.92), while extremity fractures were more common with opioid use (aOR = 7.67). No associations were found for spinal fractures, hip/thigh/pelvis fractures, or death.

Conclusion
In this study, nearly 20% of adults 55+ presenting for fall-related trauma recently used substances that impair psychomotor function. Screening for substance use in routine clinical care may reduce severity of fall-related injuries.