Abstract
Alzheimer’s disease and related dementias (ADRD), pain and chronic complex conditions (CCC) often co-occur leading to polypharmacy and with potential inappropriate medications (PIMs) use, are important risk factors for adverse drug reactions and hospitalizations in older adults. Many US veterans are at high risk for persistent pain due to age, injury or medical illness. Concerns about inadequate treatment of pain—accompanied by evidence about the analgesic efficacy of opioids—has led to an increase in the use of opioid medications to treat chronic pain in the Veterans Health Administration (VHA) and other healthcare systems. This study aims to investigate the relationship between receipt of pain medications and centrally (CNS) acting PIMs among veterans diagnosed with dementia, pain intensity, and CCC 90-days prior to hospitalization. The final analytic sample included 96,224 (81.7%) eligible older veterans from outpatient visits between October 2012–30 September 2013. We hypothesized that veterans with ADRD, and severe pain intensity may receive inappropriate pain management and CNS-acting PIMs. Seventy percent of the veterans, and especially people with ADRD, reported severe pain intensity. One in three veterans with ADRD and severe pain intensity have an increased likelihood for CNS-acting PIMs, and/or opioids. Regular assessment and re-assessment of pain among older persons with CCC, patient-centered tapering or discontinuation of opioids, alternatives to CNS-acting PIMs, and use of non-pharmacological approaches should be considered.
Highlights
Dementia is a progressive, irreversible brain syndrome that gradually affects the memory, thinking and daily functioning of those who suffer from it [1]
Veterans were generally diagnosed with multiple pain conditions, with high rates for three clusters of pain conditions, namely back pain, nontraumatic joint pain and osteoarthritis
Earlier studies investigated the prescriptions of CNS active drugs in veterans and found that 77% who were treated with opioids received psychotropic medication, such as antidepressants and anxiolytics, often leading to polypharmacy with potential side-effects [29].In this study, we, investigate the relationship between pain medications and levels of pain intensity in veterans with ADRD and chronic complex conditions (CCC), as we hypothesize that those with dementia and pain may differ in pain management and CNS-acting potential inappropriate medications (PIMs)
Summary
Irreversible brain syndrome that gradually affects the memory, thinking and daily functioning of those who suffer from it [1]. More than 47 million people worldwide live with dementia. This number is projected to triple by 2050, especially in low- and middle-income countries, where it is projected that 75% of all cases will be located [1]. Speech disruption, and acute or persistent pain are common. During the course of dementia, up to 90% develop behavioral and psychological symptoms (BPSDs) including agitation, depression and sleep disturbances [2]. Altogethe3r,odf 1e6mentia, pain and CCC increase the risk for polypharmacy and subsequently for potential inappropriate medication (PIM) use, an important risk factor for adverse drug reactions and hospitalizations (Figure 1) [4]
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