Aymen Ali Al-Qurain1,2,3, Lemlem G Gebremichael1,2, Muhammad Suleman Khan1,2, Desmond B Williams1, Lorraine Mackenzie1,2, Craig Phillips4, Patrick Russell5, Michael S Roberts1,2,6, Michael D Wiese7. 1. School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia. 2. Basil Hetzel Institute for Translational Research, The Queen Elizabeth Hospital, Woodville, Australia. 3. Saudi Arabian Cultural Mission, Ministry of Education, Riyadh, Saudi Arabia. 4. School of Nursing and Midwifery, University of South Australia, Adelaide, Australia. 5. Royal Adelaide Hospital, Adelaide, Australia. 6. Therapeutics Research Centre, Diamantina Institute, Translational Research Institute, The University of Queensland, Brisbane, Australia. 7. School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia. michael.wiese@unisa.edu.au.
Abstract
BACKGROUND: Pain is common in older patients and management guidelines rarely consider the effect of multiple comorbidities and concurrent medications on analgesic selection. OBJECTIVES: The objectives of this study were to identify the prevalence and pattern of analgesic prescribing and associated factors in older patients with polypharmacy. METHODS: Older patients (aged ≥ 75 years) admitted to the Royal Adelaide Hospital between September 2015 and August 2016 and with polypharmacy were included and their comorbidities and medications prescribed at discharge were recorded. Drug Burden Index and Charlson Comorbidity Index were calculated. The number of medications that increased the risk of orthostatic hypotension were recorded. Logistic regression was used to compute the association between analgesic use and participant characteristics, and results were presented as odds ratios and 95% confidence intervals, adjusted for age, sex, Charlson Comorbidity Index, Drug Burden Index and orthostatic hypotension. RESULTS: Over 15,000 admissions were identified, of which 1192 patients were included, 824 (69%) of whom were prescribed an analgesic medication. Paracetamol (used by 89% of analgesic users), opioids (34%) and adjuvants (17%) were used more frequently than non-steroidal anti-inflammatory drugs (8%). Analgesic users had a higher Drug Burden Index, were prescribed more medications and were less likely to be male compared with non-users. Charlson Comorbidity Index across the cohort was high (7.3 ± 1.9) but there was no difference between analgesic users and non-users, but analgesic users were more likely to have a documented diagnosis of osteoarthritis, osteoporosis and falls. Opioid use was associated with the Drug Burden Index, while adjuvant use was associated with orthostatic hypotension. Opioid use was associated with having a diagnosis of osteoporosis and falls. CONCLUSIONS: In our cohort of poly-medicated elderly patients, prescription of analgesic medications was common, and these patients are likely to have an increased rate of adverse drug reactions and falls compared with those who were not prescribed analgesic medications.
BACKGROUND:Pain is common in older patients and management guidelines rarely consider the effect of multiple comorbidities and concurrent medications on analgesic selection. OBJECTIVES: The objectives of this study were to identify the prevalence and pattern of analgesic prescribing and associated factors in older patients with polypharmacy. METHODS: Older patients (aged ≥ 75 years) admitted to the Royal Adelaide Hospital between September 2015 and August 2016 and with polypharmacy were included and their comorbidities and medications prescribed at discharge were recorded. Drug Burden Index and Charlson Comorbidity Index were calculated. The number of medications that increased the risk of orthostatic hypotension were recorded. Logistic regression was used to compute the association between analgesic use and participant characteristics, and results were presented as odds ratios and 95% confidence intervals, adjusted for age, sex, Charlson Comorbidity Index, Drug Burden Index and orthostatic hypotension. RESULTS: Over 15,000 admissions were identified, of which 1192 patients were included, 824 (69%) of whom were prescribed an analgesic medication. Paracetamol (used by 89% of analgesic users), opioids (34%) and adjuvants (17%) were used more frequently than non-steroidal anti-inflammatory drugs (8%). Analgesic users had a higher Drug Burden Index, were prescribed more medications and were less likely to be male compared with non-users. Charlson Comorbidity Index across the cohort was high (7.3 ± 1.9) but there was no difference between analgesic users and non-users, but analgesic users were more likely to have a documented diagnosis of osteoarthritis, osteoporosis and falls. Opioid use was associated with the Drug Burden Index, while adjuvant use was associated with orthostatic hypotension. Opioid use was associated with having a diagnosis of osteoporosis and falls. CONCLUSIONS: In our cohort of poly-medicated elderly patients, prescription of analgesic medications was common, and these patients are likely to have an increased rate of adverse drug reactions and falls compared with those who were not prescribed analgesic medications.
Authors: W Zhang; G Nuki; R W Moskowitz; S Abramson; R D Altman; N K Arden; S Bierma-Zeinstra; K D Brandt; P Croft; M Doherty; M Dougados; M Hochberg; D J Hunter; K Kwoh; L S Lohmander; P Tugwell Journal: Osteoarthritis Cartilage Date: 2010-02-11 Impact factor: 6.576
Authors: Kris M Jamsen; Justin P Turner; Sepehr Shakib; Nimit Singhal; Jonathon Hogan-Doran; Robert Prowse; Sally Johns; J Simon Bell Journal: Drugs Real World Outcomes Date: 2015-06
Authors: Suzanne G Leveille; Richard N Jones; Dan K Kiely; Jeffrey M Hausdorff; Robert H Shmerling; Jack M Guralnik; Douglas P Kiel; Lewis A Lipsitz; Jonathan F Bean Journal: JAMA Date: 2009-11-25 Impact factor: 56.272
Authors: Aymen Ali Al-Qurain; Lemlem G Gebremichael; Mohammed S Khan; Desmond B Williams; Lorraine Mackenzie; Craig Phillips; Patrick Russell; Michael S Roberts; Michael D Wiese Journal: Int J Clin Pharm Date: 2020-11-18
Authors: Tatyana Mollayeva; Andrew Tran; Vincy Chan; Angela Colantonio; Michael D Escobar Journal: BMC Med Res Methodol Date: 2022-01-30 Impact factor: 4.615
Authors: Aymen A Al-Qurain; Richard N Upton; Rami Tadros; Michael S Roberts; Michael D Wiese Journal: Eur J Drug Metab Pharmacokinet Date: 2022-02-15 Impact factor: 2.569