Journal Article

Patterns and predictors of chronic opioid use in older adults: A retrospective cohort study

Fardo, David W., Moga, Daniela C., Oh, GYeon, Abner, Erin L., Freeman, Patricia R.

2019

Overview

Given the controversy around the effectiveness of opioid treatment for chronic pain and the lack of detailed guidance for prescribing opioids in older adults, the objectives of this study were to estimate the trajectories and predictors of opioid use in older adults. Data were extracted from the National Alzheimer's Coordinating Center (2005-2017). Group-based trajectory modeling was used to identify the patterns of opioid use (any or strong) among participants age 65+. We used multivariable logistic regression with backward selection to evaluate demographics and comorbidities as potential predictors of trajectory membership. Among 13,059 participants, four trajectories were identified for the use of both any opioids and strong opioids (minimal-users, incident chronic-users, discontinuing-users, and prevalent chronic-users). For any opioids, female sex (adjusted odds ratio = 1.23; 95% confidence interval = 1.03-1.46), black vs. white (1.47; 1.18-1.82), year of education (0.96; 0.94-0.99), type of residence (independent group vs. private: 1.77; 1.38-2.26, care facility vs. private: 1.89; 1.20-2.97), hypertension (1.44; 1.20-1.72), cardiovascular disease (1.30; 1.09-1.55), urinary incontinence (1.45; 1.19-1.78), dementia (0.73; 0.57-0.92), number of medications (1 to 4 vs. none: 0.48; 0.36-0.64, 5 or more vs. none: 0.67; 0.50-0.88), and antidepressant agent (1.38; 1.14-1.67) were associated with incident chronic-use vs. non-use. For strong opioids, female sex (1.27; 1.04-1.56), type of residence (independent group vs. private: 1.90; 1.43-2.53, care facility vs. private: 2.37; 1.44-3.90), current smoking (1.68; 1.09-2.60), hypertension (1.49; 1.21-1.83), urinary incontinence (1.45; 1.14-1.84), dementia (0.73; 0.55-0.97), number of medications (1 to 4 vs. none: 0.46; 0.32-0.65, 5 or more vs. none: 0.59; 0.42-0.83), and antidepressant agent (1.55; 1.24-1.93) were associated with incident chronic-use vs. non-use. Given that chronic opioid use was more prevalent in participants who were more vulnerable (i.e., older age, with multiple comorbidities, and polypharmacy), further studies should evaluate the safety and efficacy of using opioids in this population.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adults / Age / Aged / Aged, 80 and over / Aging / Alzheimer's disease / Analgesics / Analgesics, Opioid - administration & dosage / Analgesics, Opioid - therapeutic use / Antidepressants / Blood pressure / Cancer / Cardiovascular diseases / Care and treatment / Chronic pain / Chronic Pain - drug therapy / Chronic Pain - epidemiology / Cohort analysis / Cohort Studies / Comorbidity / Confidence intervals / Databases, Factual / Dementia / Dementia disorders / Demographics / Demography / Drugs / Efficacy / Elderly / Epidemiology / Family medical history / Female / Females / Health aspects / Humans / Hypertension / Incontinence / Logistic Models / Male / Medicine and Health Sciences / Methods / Narcotics / Older people / Opiates / Opioid-Related Disorders - epidemiology / Opioids / Pain / Pain management / People and Places / Pharmacy / Polypharmacy / Population / Prescribing / Prescription drugs / Public health / Residence / Retrospective Studies / Risk factors / Safety and security measures / Sex / Sex Factors / Sex ratio / Smoking / Sociology / Statistical analysis / Trajectory analysis / Treatment outcomes / Trends / United States - epidemiology / Urinary incontinence