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

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    Authors
    Hunnicutt, Jacob N.
    Chrysanthopoulou, Stavroula A.
    Ulbricht, Christine M.
    Hume, Anne L.
    Tjia, Jennifer
    Lapane, Kate L.
    UMass Chan Affiliations
    Department of Quantitative Health Sciences
    Document Type
    Journal Article
    Publication Date
    2017-09-21
    Keywords
    UMCCTS funding
    nursing homes
    opioids
    pain adjuvants
    pain management
    Chemical Actions and Uses
    Geriatrics
    Musculoskeletal, Neural, and Ocular Physiology
    Pathological Conditions, Signs and Symptoms
    Psychological Phenomena and Processes
    Therapeutics
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    Link to Full Text
    https://doi.org/10.1111/jgs.15080
    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.
    Source

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

    DOI
    10.1111/jgs.15080
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/29175
    PubMed ID
    28940193
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    ae974a485f413a2113503eed53cd6c53
    10.1111/jgs.15080
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