University of Massachusetts Medical School Faculty Publications

Title

Prevalence of Long-Term Opioid Use in Long-Stay Nursing Home Residents

UMMS Affiliation

Department of Quantitative Health Sciences

Publication Date

2017-09-21

Document Type

Article

Disciplines

Chemical Actions and Uses | Geriatrics | Musculoskeletal, Neural, and Ocular Physiology | Pathological Conditions, Signs and Symptoms | Psychological Phenomena and Processes | Therapeutics

Abstract

BACKGROUND/OBJECTIVES: Overall and long-term opioid use among older adults have increased since 1999. Less is known about opioid use in older adults in nursing homes (NHs).

DESIGN: Cross-sectional.

SETTING: U.S. NHs (N = 13,522).

PARTICIPANTS: Long-stay NH resident Medicare beneficiaries with a Minimum Data Set 3.0 (MDS) assessment between April 1, 2012, and June 30, 2012, and 120 days of follow-up (N = 315,949).

MEASUREMENTS: We used Medicare Part D claims to measure length of opioid use in the 120 days from the index assessment (short-term: < /=30 days, medium-term: > 30-89 days, long-term: > /=90 days), adjuvants (e.g., anticonvulsants), and other pain medications (e.g., corticosteroids). MDS assessments in the follow-up period were used to measure nonpharmacological pain management use. Modified Poisson models were used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for age, gender, race and ethnicity, cognitive and physical impairment, and long-term opioid use.

RESULTS: Of all long-stay residents, 32.4% were prescribed any opioid, and 15.5% were prescribed opioids long-term. Opioid users (versus nonusers) were more commonly prescribed pain adjuvants (32.9% vs 14.9%), other pain medications (25.5% vs 11.0%), and nonpharmacological pain management (24.5% vs 9.3%). Long-term opioid use was higher in women (aPR = 1.21, 95% CI = 1.18-1.23) and lower in racial and ethnic minorities (non-Hispanic blacks vs whites: APR = 0.93, 95% CI = 0.90-0.94) and those with severe cognitive impairment (vs no or mild impairment, aPR = 0.82, 95% CI = 0.79-0.83).

CONCLUSION: One in seven NH residents was prescribed opioids long-term. Recent guidelines on opioid prescribing for pain recommend reducing long-term opioid use, but this is challenging in NHs because residents may not benefit from nonpharmacological and nonopioid interventions. Studies to address concerns about opioid safety and effectiveness (e.g., on pain and functional status) in NHs are needed.

Keywords

UMCCTS funding, nursing homes, opioids, pain adjuvants, pain management

DOI of Published Version

10.1111/jgs.15080

Source

J Am Geriatr Soc. 2017 Sep 21. doi: 10.1111/jgs.15080. [Epub ahead of print] Link to article on publisher's site

Related Resources

Link to Article in PubMed

Journal/Book/Conference Title

Journal of the American Geriatrics Society

PubMed ID

28940193

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