ADRD as Additional Risk Factor for Adverse Events Among Opioid-Using Older Adults

Abstract

<h3>Introduction</h3> The high prevalence of Alzheimer's Disease and Related Dementias (ADRD) presents a challenge for patients, caregivers, and society in general. Nationally, there are about 6 million people with an ADRD diagnosis which is projected to triple to 13.8 million people by 2050.[1] The prevalence of opioid use has been growing throughout the opioid crisis, and will increase in geriatric populations as the aging boomers transition to older adulthood.[2] Both opioid use and ADRD are risk factors for adverse events such as falls, aspiration, and GI/GU complications. [3,4] They are also each significantly associated with an increase in morbidity and mortality. Understanding the combined risk of ADRD and opioids will be important to inform prescribing practices to minimize the risk of adverse events in this vulnerable population. Using the South Carolina Alzheimer's Disease Registry, this study compares rates of inpatient hospitalizations and ED visits by opioid-using ADRD and non-ADRD older adults. <h3>Methods</h3> This is a retrospective study conducted by chart review of adults aged 50 years and older in the South Carolina Alzheimer's Disease Registry between the years 2010-2017.Rates of inpatient hospitalizations and ED visits of ADRD and non-ADRD adults were compared. Both populations were documented to have been using an opioid that contributed to the hospitalization or ED visit. These records were obtained from hospital medical records, discharge records, and ICD codes recorded in the registry. Generalized linear models were used to determine if changes in presentation rates over the study period were significant. <h3>Results</h3> 175,402 adults aged 50 or older with dementia diagnosis between 2010-1017 were reviewed. Composition of cohort by age was as follows: 50 to 59 years of age (5%), 60 to 69 years of age (16%), 70 to 79 years of age (30%), 80 years of age or older (49%). 62% of Cohort was Female. Racial composition was as follows: White (65%), Black/AA (23%), Other/Unknown (12%) Breakdown of dementia type was as follows: Alzheimer's (71%), Vascular (9%), Mixed (3%), Other (17%). ADRD cohort members demonstrated a higher rate of opioid-related inpatient hospitalizations than similar-aged people in the general population (Table 1), with a relative risk ratio of 3.2. Similarly, ADRD cohort members demonstrated a higher rate of opioid-related ED visits than similar-aged people in the general population (Table 2), with a relative risk ratio of 2.1. Rate differences were observed by age group, with younger ADRD age groups having the highest opioid-related inpatient and ED visits rates compared to same age groups in the general population. As age increased, opioid-related inpatient and ED visit rates, although higher, were closer to rates observed for the same age groups in the general population. All 4 age cohorts within ADRD and non-ADRD populations were combined into one age cohort comprised of age >50, and examined for statistically significant differences in inpatient hospitalization and ED visit rates over time. The differences were significant in the Non-ADRD inpatient cohort (p=0.0001), as well as both the ADRD and non-ADRD cohort for ED visits (p=0.0001). Only the inpatient ADRD cohort did not exhibit statistically significant differences (p=0.4664) <h3>Conclusions</h3> The preliminary results of this investigation suggest that an ADRD diagnosis may increase the risk of adverse events among opioid-using older adults. Observed differences in outcomes among younger age cohorts may suggest differing severities due to varying type (eg early onset, substance related) as well as differences in care settings between older and younger cohorts. Hazard ratios are strongly suggestive of higher rates of inpatient hospitalization and ED visits in opioid-using ADRD patients. Further statistical analysis of each age cohort separately is necessary to further the strength and validity of this study. <h3>This research was funded by</h3> None reported. Chart: https://apps.aagponline.org/abstracts/uploads/2022/t11gi0i74fv6q8a.pdf