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dc.contributor.authorLiu, Shao-Hsien
dc.contributor.authorHunnicutt, Jacob N.
dc.contributor.authorUlbricht, Christine M.
dc.contributor.authorDube, Catherine E
dc.contributor.authorHume, Anne L.
dc.contributor.authorLapane, Kate L.
dc.date2022-08-11T08:10:35.000
dc.date.accessioned2022-08-23T17:13:42Z
dc.date.available2022-08-23T17:13:42Z
dc.date.issued2019-06-01
dc.date.submitted2019-06-07
dc.identifier.citation<p>Drugs Aging. 2019 Jun;36(6):549-557. doi: 10.1007/s40266-019-00650-3. <a href="https://doi.org/10.1007/s40266-019-00650-3">Link to article on publisher's site</a></p>
dc.identifier.issn1170-229X (Linking)
dc.identifier.doi10.1007/s40266-019-00650-3
dc.identifier.pmid30924097
dc.identifier.urihttp://hdl.handle.net/20.500.14038/46791
dc.description.abstractOBJECTIVES: Our objective was to describe the prevalence of adjuvants to opioid therapy and changes in these agents for pharmacologic management in nursing home residents with cancer. METHODS: We included Medicare beneficiaries with cancer and documented opioid use at nursing home admission in 2011-2013 (N = 3268). The Minimum Data Set 3.0 provided information on sociodemographic and clinical characteristics. Part D claims provided information on opioid and adjuvant use during the 7 days after admission and 90 days later. Proportions of changes in these agents were estimated. Separate logistic models estimated associations between resident characteristics and (1) use of adjuvants at admission and (2) intensification of pharmacologic management at 90 days. RESULTS: Nearly 20% of patients received adjuvants to opioids at admission, with gabapentin the most common adjuvant (34.4%). After 90 days, approximately 25% had maintained or intensified pharmacologic management. While advanced age ( > /= 85 vs. 65-74 years, adjusted odds ratio [aOR] 0.80; 95% confidence interval [CI] 0.63-1.02) and comorbidities, including dementia (aOR 0.65; 95% CI 0.53-0.82) and depression (aOR 1.55; 95% CI 1.29-1.87), were associated with adjuvant use at admission, worse cognitive impairment (severe vs. no/mild, aOR 0.80; 95% CI 0.64-0.99) and presence of more severe pain (moderate/severe vs. no pain, aOR 1.60; 95% CI 1.26-2.03) were associated with intensification of drug regimen. CONCLUSION: Given aging-related changes and the presence of comorbid conditions in older adults, safety studies of these practices are warranted.
dc.language.isoen_US
dc.relation<p><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=30924097&dopt=Abstract">Link to Article in PubMed</a></p>
dc.relation.urlhttps://doi.org/10.1007/s40266-019-00650-3
dc.subjectClinical Epidemiology
dc.subjectEpidemiology
dc.subjectGeriatrics
dc.subjectHealth Services Research
dc.subjectMedical Pharmacology
dc.subjectNeoplasms
dc.subjectPain Management
dc.subjectPharmaceutical Preparations
dc.subjectTherapeutics
dc.titleAdjuvant Use and the Intensification of Pharmacologic Management for Pain in Nursing Home Residents with Cancer: Data from a US National Database
dc.typeJournal Article
dc.source.journaltitleDrugs and aging
dc.source.volume36
dc.source.issue6
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/qhs_pp/1256
dc.identifier.contextkey14691225
html.description.abstract<p>OBJECTIVES: Our objective was to describe the prevalence of adjuvants to opioid therapy and changes in these agents for pharmacologic management in nursing home residents with cancer.</p> <p>METHODS: We included Medicare beneficiaries with cancer and documented opioid use at nursing home admission in 2011-2013 (N = 3268). The Minimum Data Set 3.0 provided information on sociodemographic and clinical characteristics. Part D claims provided information on opioid and adjuvant use during the 7 days after admission and 90 days later. Proportions of changes in these agents were estimated. Separate logistic models estimated associations between resident characteristics and (1) use of adjuvants at admission and (2) intensification of pharmacologic management at 90 days.</p> <p>RESULTS: Nearly 20% of patients received adjuvants to opioids at admission, with gabapentin the most common adjuvant (34.4%). After 90 days, approximately 25% had maintained or intensified pharmacologic management. While advanced age ( > /= 85 vs. 65-74 years, adjusted odds ratio [aOR] 0.80; 95% confidence interval [CI] 0.63-1.02) and comorbidities, including dementia (aOR 0.65; 95% CI 0.53-0.82) and depression (aOR 1.55; 95% CI 1.29-1.87), were associated with adjuvant use at admission, worse cognitive impairment (severe vs. no/mild, aOR 0.80; 95% CI 0.64-0.99) and presence of more severe pain (moderate/severe vs. no pain, aOR 1.60; 95% CI 1.26-2.03) were associated with intensification of drug regimen.</p> <p>CONCLUSION: Given aging-related changes and the presence of comorbid conditions in older adults, safety studies of these practices are warranted.</p>
dc.identifier.submissionpathqhs_pp/1256
dc.contributor.departmentDivision of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences
dc.source.pages549-557


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