Prevalence of Long‐Term Opioid Use in Long‐Stay Nursing Home Residents

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 66; no. 1; pp. 48 - 55
• Main Authors: Hunnicutt, Jacob N, Chrysanthopoulou, Stavroula A, Ulbricht, Christine M, Hume, Anne L, Tjia, Jennifer, Lapane, Kate L
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-01-2018
• Subjects: Adjuvants; Aged, 80 and over; Analgesics, Opioid - therapeutic use; Anticonvulsants; Cognitive ability; Corticosteroids; Cross-Sectional Studies; Female; Humans; Male; Medicare; Medicare Part D - statistics & numerical data; Minority & ethnic groups; Narcotics; Nursing homes; Nursing Homes - statistics & numerical data; Older people; Opioids; Pain; Pain - drug therapy; Pain - epidemiology; pain adjuvants; Pain management; Pain Management - statistics & numerical data; Practice Patterns, Physicians; Prevalence; United States - epidemiology; United States; pain management; pain adjuvants; nursing homes; opioids
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.15080

Background/Objectives
Overall and long‐term opioid use among older adults have increased since 1999. Less is known about opioid use in older adults in nursing homes (NHs).
Design
Cross‐sectional.
Setting
U.S. NHs (N = 13,522).
Participants
Long‐stay NH resident Medicare beneficiaries with a Minimum Data Set 3.0 (MDS) assessment between April 1, 2012, and June 30, 2012, and 120 days of follow‐up (N = 315,949).
Measurements
We used Medicare Part D claims to measure length of opioid use in the 120 days from the index assessment (short‐term: ≤30 days, medium‐term: >30–89 days, long‐term: ≥90 days), adjuvants (e.g., anticonvulsants), and other pain medications (e.g., corticosteroids). MDS assessments in the follow‐up period were used to measure nonpharmacological pain management use. Modified Poisson models were used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for age, gender, race and ethnicity, cognitive and physical impairment, and long‐term opioid use.
Results
Of all long‐stay residents, 32.4% were prescribed any opioid, and 15.5% were prescribed opioids long‐term. Opioid users (versus nonusers) were more commonly prescribed pain adjuvants (32.9% vs 14.9%), other pain medications (25.5% vs 11.0%), and nonpharmacological pain management (24.5% vs 9.3%). Long‐term opioid use was higher in women (aPR = 1.21, 95% CI = 1.18–1.23) and lower in racial and ethnic minorities (non‐Hispanic blacks vs whites: APR = 0.93, 95% CI = 0.90–0.94) and those with severe cognitive impairment (vs no or mild impairment, aPR = 0.82, 95% CI = 0.79–0.83).
Conclusion
One in seven NH residents was prescribed opioids long‐term. Recent guidelines on opioid prescribing for pain recommend reducing long‐term opioid use, but this is challenging in NHs because residents may not benefit from nonpharmacological and nonopioid interventions. Studies to address concerns about opioid safety and effectiveness (e.g., on pain and functional status) in NHs are needed.