Abstract
BackgroundCentral nervous system depressant medications (CNSDs) such as opioid analgesics and sedative-hypnotics are commonly prescribed to older patients for the treatment of chronic pain, anxiety and insomnia. Yet, while many studies reported potential harms, it remains unknown whether persistent use of these medications is beneficial for older patients’ self-reported health-related quality of life (HRQoL). The present study clarified this knowledge gap through comparing HRQoL of hospitalized older patients with versus without using CNSD drugs for ≥4 weeks. Moreover, we explored the relationship between such use and HRQoL, adjusting for the effects of polypharmacy, comorbidity burden and other clinically relevant covariates.MethodsThe study was cross-sectional and included 246 older patients recruited consecutively from somatic departments of a large regional university hospital in Norway. We defined prolonged CNSD use as using opioids, benzodiazepines and/or z-hypnotics for ≥4 weeks. Patients’ self-reported HRQoL were measured with scales of the EuroQol EQ-5D-3L instrument. Data analyses were mainly descriptive statistics and regression models.ResultsPatients with prolonged use of CNSDs reported lower scores on both EQ-5D index and EQ VAS compared with those without such use (p < 0.001). They had higher odds of having more problems performing usual activities (OR = 3.37, 95% CI: 1.40 to 8.13), pain/discomfort (OR = 2.06, 95% CI: 1.05 to 4.04), and anxiety/depression (OR = 3.77, 95% CI: 1.82 to 7.82).In multivariable regression models, there was no significant association between prolonged CNSD use and HRQoL when including pain as a predictor variable. In models not including pain, CNSD use was strongly associated with HRQoL (adjusted for sociodemographic background, polypharmacy, comorbidity, anxiety and depressive symptoms, regression coefficient − 0.19 (95% CI, − 0.31 to − 0.06).ConclusionsOlder patients with prolonged CNSD use reported poorer HRQoL. They also had more pain and higher depression scores. Prolonged use of CNSDs was not independently associated with higher HRQoL.
Highlights
Central nervous system depressant medications (CNSDs) such as opioid analgesics and sedativehypnotics are commonly prescribed to older patients for the treatment of chronic pain, anxiety and insomnia
Participants with prolonged use of CNSDs comprised a higher proportion of females, were older, had less education, more polypharmacy, more comorbidity and higher pain intensity and depression scores than those without prolonged use (Table 1)
Association between prolonged use of CNSDs and health-related quality of life (HRQoL) in multivariable analyses Dimensions of HRQoL In multiple logistic regression analyses (Table 3), we found that the odds of having extreme versus moderate/ no pain or discomfort, and the odds of having moderate/extreme versus no pain or discomfort for patients with prolonged CNSD use were about two times higher than that of those without such use (OR = 2.06, 95% confidence interval (CI) 1.05 to 4.04)
Summary
Central nervous system depressant medications (CNSDs) such as opioid analgesics and sedativehypnotics are commonly prescribed to older patients for the treatment of chronic pain, anxiety and insomnia. While many studies reported potential harms, it remains unknown whether persistent use of these medications is beneficial for older patients’ self-reported health-related quality of life (HRQoL). Anxiety and insomnia are common in old age [6] Pharmacological therapy of these conditions may involve the use of central nervous system depressant medications (CNSDs) such as opioid analgesics, benzodiazepines and z-hypnotics [7]. These medications are frequently prescribed, long-term effectiveness among older people was not shown [8, 9]. Overuse of benzodiazepines and z-hypnotics likewise was found to be associated with reduced cognitive function, road-traffic accidents, respiratory depression, fractures, falls, and suicide [12, 13]
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