Hemalkumar B Mehta1, Yong-Fang Kuo2, Mukaila Raji3, Shuang Li3, Jordan Westra2, James S Goodwin3. 1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: hbmehta@jhu.edu. 2. Office of Biostatistics, Department of Preventive Medicine and Population Health, The University of Texas Medical Branch at Galveston, Galveston, TX, USA. 3. Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, USA.
Abstract
OBJECTIVE: Current information on opioid use in nursing home residents, particularly those with dementia, is unknown. We examined the temporal trends in opioid use by dementia severity and the association of dementia severity with opioid use in long-term care nursing home residents. DESIGN: Repeated measures cross-sectional study. SETTING: Long-term care nursing homes. PARTICIPANTS: Using 20% Minimum Data Set (MDS) and Medicare claims from 2011-2017, we included long-term care residents (n = 734,739) from each year who had 120 days of consecutive stay. In a secondary analysis, we included residents who had an emergency department visit for a fracture (n = 12,927). MEASUREMENTS: Dementia was classified as no, mild, moderate, and severe based on the first MDS assessment each year. In the 120 days of nursing home stay, opioid use was measured as any, prolonged (>90 days), and high-dose (≥90 morphine milligram equivalent dose/day). For residents with a fracture, opioid use was measured within 7 days after emergency department discharge. Association of dementia severity with opioid use was evaluated using logistic regression. RESULTS: Overall, any opioid use declined by 8.5% (35.2% to 32.2%, P < .001), prolonged use by 5.0% (14.1% to 13.4%, P < .001), and high-dose by 21.4% (1.4% to 1.1%, P < .001) from 2011 to 2017. Opioid use declined across 4 dementia severity groups. Among residents with fracture, opioid use declined by 9% in mild, 9.5% in moderate, and 12.3% in severe dementia. The odds of receiving any, prolonged, and high-dose opioids decreased with increasing severity of dementia. For example, severe dementia reduced the odds of any [23.5% vs 47.6%; odds ratio (OR) 0.56, 95% confidence interval (CI) 0.55-0.57], prolonged (9.8% vs 20.7%; OR 0.69, 95% CI 0.67-0.71), and high-dose (1.0% vs 2.3%; OR 0.69, 95% CI 0.63-0.74) opioids. CONCLUSIONS AND IMPLICATIONS: Use of opioids declined in nursing home residents from 2011 to 2017, and the use was lower in residents with dementia, possibly reflecting suboptimal pain management in this population.
OBJECTIVE: Current information on opioid use in nursing home residents, particularly those with dementia, is unknown. We examined the temporal trends in opioid use by dementia severity and the association of dementia severity with opioid use in long-term care nursing home residents. DESIGN: Repeated measures cross-sectional study. SETTING: Long-term care nursing homes. PARTICIPANTS: Using 20% Minimum Data Set (MDS) and Medicare claims from 2011-2017, we included long-term care residents (n = 734,739) from each year who had 120 days of consecutive stay. In a secondary analysis, we included residents who had an emergency department visit for a fracture (n = 12,927). MEASUREMENTS: Dementia was classified as no, mild, moderate, and severe based on the first MDS assessment each year. In the 120 days of nursing home stay, opioid use was measured as any, prolonged (>90 days), and high-dose (≥90 morphine milligram equivalent dose/day). For residents with a fracture, opioid use was measured within 7 days after emergency department discharge. Association of dementia severity with opioid use was evaluated using logistic regression. RESULTS: Overall, any opioid use declined by 8.5% (35.2% to 32.2%, P < .001), prolonged use by 5.0% (14.1% to 13.4%, P < .001), and high-dose by 21.4% (1.4% to 1.1%, P < .001) from 2011 to 2017. Opioid use declined across 4 dementia severity groups. Among residents with fracture, opioid use declined by 9% in mild, 9.5% in moderate, and 12.3% in severe dementia. The odds of receiving any, prolonged, and high-dose opioids decreased with increasing severity of dementia. For example, severe dementia reduced the odds of any [23.5% vs 47.6%; odds ratio (OR) 0.56, 95% confidence interval (CI) 0.55-0.57], prolonged (9.8% vs 20.7%; OR 0.69, 95% CI 0.67-0.71), and high-dose (1.0% vs 2.3%; OR 0.69, 95% CI 0.63-0.74) opioids. CONCLUSIONS AND IMPLICATIONS: Use of opioids declined in nursing home residents from 2011 to 2017, and the use was lower in residents with dementia, possibly reflecting suboptimal pain management in this population.
Authors: Andrea Iaboni; Michael A Campitelli; Susan E Bronskill; Christina Diong; Matthew Kumar; Laura C Maclagan; Tara Gomes; Mina Tadrous; Colleen J Maxwell Journal: CMAJ Open Date: 2019-09-23
Authors: Sascha Dublin; Rod L Walker; Shelly L Gray; Rebecca A Hubbard; Melissa L Anderson; Onchee Yu; Paul K Crane; Eric B Larson Journal: J Am Geriatr Soc Date: 2015-08 Impact factor: 5.562
Authors: Hemalkumar B Mehta; Yong-Fang Kuo; Mukaila A Raji; Jordan Westra; Cynthia Boyd; G Caleb Alexander; James S Goodwin Journal: J Am Med Dir Assoc Date: 2021-05-19 Impact factor: 4.669
Authors: Anita Iacono; Michael A Campitelli; Susan E Bronskill; David B Hogan; Andrea Iaboni; Laura C Maclagan; Tara Gomes; Mina Tadrous; Charity Evans; Andrea Gruneir; Qi Guan; Thomas Hadjistavropoulos; Cecilia Cotton; Sudeep S Gill; Dallas P Seitz; Joanne Ho; Colleen J Maxwell Journal: Drugs Aging Date: 2022-08-17 Impact factor: 4.271