Andrew W Bergen1, Gulcan Cil2, Lana J Sargent3,4, Chintan V Dave5,6. 1. Oregon Research Institute, Eugene, OR, USA. abergen@ori.org. 2. Oregon Research Institute, Eugene, OR, USA. 3. School of Nursing, Virginia Commonwealth University, Richmond, VA, USA. 4. Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA. 5. Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA. 6. Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, USA.
Abstract
INTRODUCTION: Limited evidence for incident frailty risks associated with prescription analgesics and sedatives in older (≥ 65 years) community-living adults prompted a more comprehensive investigation. METHODS: We used data from older Health and Retirement Study respondents and three frailty models (frailty index, functional domain, frailty phenotype with 8803, 10,470, and 6850 non-frail individuals, respectively) and estimated sub-hazard ratios of regular prescription drug use (co-use, analgesic use, and sedative use), by frailty model. We addressed confounding with covariate adjustment and propensity score matching approaches. RESULTS: The baseline prevalence of analgesic and sedative co-use, analgesic use, and sedative use among non-frail respondents was 1.8%, 12.8%, and 4.7% for the frailty index model, 4.2%, 16.2%, and 5.3% for the functional domain model, and 4.3%, 15.4%, and 6.1% for the frailty phenotype model, respectively. Cumulative frailty incidence over 10 years was 39.3%, 36.1%, and 14.2% for frailty index, functional domain, and frailty phenotype models, respectively; covariate-adjusted sub-hazard ratio estimates were 2.00 (1.63-2.45), 1.83 (1.57-2.13), and 1.68 (1.21-2.33) for co-use; 1.72 (1.56-1.89), 1.38 (1.27-1.51), and 1.51 (1.27-1.79) for analgesic use; and 1.46 (1.24-1.72), 1.25 (1.07-1.46), and 1.31 (0.97-1.76) for sedative use. Frailty risk ranking (co-use > analgesic use > sedative use) persisted across all model sensitivity analyses. DISCUSSION: Consistently significant frailty risk estimates of regular prescription analgesic and sedative co-use and of prescription analgesic use support existing clinical, public health, and regulatory guidance on opioid and benzodiazepine co-prescription, on opioid prescription, and on NSAID prescription. Frailty phenotype measurement administration limited power to detect significant frailty risks. Research into specific pharmaceutical exposures and comparison of results across cohorts will be required to contribute to the deprescribing evidence base.
INTRODUCTION: Limited evidence for incident frailty risks associated with prescription analgesics and sedatives in older (≥ 65 years) community-living adults prompted a more comprehensive investigation. METHODS: We used data from older Health and Retirement Study respondents and three frailty models (frailty index, functional domain, frailty phenotype with 8803, 10,470, and 6850 non-frail individuals, respectively) and estimated sub-hazard ratios of regular prescription drug use (co-use, analgesic use, and sedative use), by frailty model. We addressed confounding with covariate adjustment and propensity score matching approaches. RESULTS: The baseline prevalence of analgesic and sedative co-use, analgesic use, and sedative use among non-frail respondents was 1.8%, 12.8%, and 4.7% for the frailty index model, 4.2%, 16.2%, and 5.3% for the functional domain model, and 4.3%, 15.4%, and 6.1% for the frailty phenotype model, respectively. Cumulative frailty incidence over 10 years was 39.3%, 36.1%, and 14.2% for frailty index, functional domain, and frailty phenotype models, respectively; covariate-adjusted sub-hazard ratio estimates were 2.00 (1.63-2.45), 1.83 (1.57-2.13), and 1.68 (1.21-2.33) for co-use; 1.72 (1.56-1.89), 1.38 (1.27-1.51), and 1.51 (1.27-1.79) for analgesic use; and 1.46 (1.24-1.72), 1.25 (1.07-1.46), and 1.31 (0.97-1.76) for sedative use. Frailty risk ranking (co-use > analgesic use > sedative use) persisted across all model sensitivity analyses. DISCUSSION: Consistently significant frailty risk estimates of regular prescription analgesic and sedative co-use and of prescription analgesic use support existing clinical, public health, and regulatory guidance on opioid and benzodiazepine co-prescription, on opioid prescription, and on NSAID prescription. Frailty phenotype measurement administration limited power to detect significant frailty risks. Research into specific pharmaceutical exposures and comparison of results across cohorts will be required to contribute to the deprescribing evidence base.
Authors: Jennifer S Albrecht; Emerson M Wickwire; Aparna Vadlamani; Steven M Scharf; Sarah E Tom Journal: Am J Geriatr Psychiatry Date: 2018-11-02 Impact factor: 4.105
Authors: Paula Pop; Susan E Bronskill; Katrina L Piggott; Nathan M Stall; Rachel D Savage; Jessica D Visentin; Lisa M McCarthy; Vasily Giannakes; Wei Wu; Andrea Gruneir; Jodi M Gatley; Paula A Rochon Journal: J Am Geriatr Soc Date: 2019-06-21 Impact factor: 5.562
Authors: Jennifer Brennan Braden; Alicia Young; Mark D Sullivan; Brian Walitt; Andrea Z Lacroix; Lisa Martin Journal: J Pain Date: 2012-01 Impact factor: 5.820
Authors: L P Fried; C M Tangen; J Walston; A B Newman; C Hirsch; J Gottdiener; T Seeman; R Tracy; W J Kop; G Burke; M A McBurnie Journal: J Gerontol A Biol Sci Med Sci Date: 2001-03 Impact factor: 6.053
Authors: Erin E Krebs; Amy Gravely; Sean Nugent; Agnes C Jensen; Beth DeRonne; Elizabeth S Goldsmith; Kurt Kroenke; Matthew J Bair; Siamak Noorbaloochi Journal: JAMA Date: 2018-03-06 Impact factor: 56.272
Authors: Laxmaiah Manchikanti; Adam M Kaye; Nebojsa Nick Knezevic; Heath McAnally; Konstantin Slavin; Andrea M Trescot; Susan Blank; Vidyasagar Pampati; Salahadin Abdi; Jay S Grider; Alan D Kaye; Kavita N Manchikanti; Harold Cordner; Christopher G Gharibo; Michael E Harned; Sheri L Albers; Sairam Atluri; Steve M Aydin; Sanjay Bakshi; Robert L Barkin; Ramsin M Benyamin; Mark V Boswell; Ricardo M Buenaventura; Aaron K Calodney; David L Cedeno; Sukdeb Datta; Timothy R Deer; Bert Fellows; Vincent Galan; Vahid Grami; Hans Hansen; Standiford Helm Ii; Rafael Justiz; Dhanalakshmi Koyyalagunta; Yogesh Malla; Annu Navani; Kent H Nouri; Ramarao Pasupuleti; Nalini Sehgal; Sanford M Silverman; Thomas T Simopoulos; Vijay Singh; Daneshvari R Solanki; Peter S Staats; Ricardo Vallejo; Bradley W Wargo; Arthur Watanabe; Joshua A Hirsch Journal: Pain Physician Date: 2017-02 Impact factor: 4.965
Authors: Kenneth Rockwood; Xiaowei Song; Chris MacKnight; Howard Bergman; David B Hogan; Ian McDowell; Arnold Mitnitski Journal: CMAJ Date: 2005-08-30 Impact factor: 8.262