Abstract
BackgroundPain is common among individuals with Alzheimer’s disease and related dementias (ADRD), and use of opioids has been increasing over the last decade. Yet, it is unclear to what extent opioids are appropriately prescribed for patients with ADRD and whether the appropriateness of opioid prescribing differs by ADRD status. The objective of this study is to compare the quality of opioid prescribing among patients with or without ADRD who have chronic noncancer pain.MethodsA nationally representative cohort study of Medicare beneficiaries aged 50 years or older who had chronic pain but who had no cancer, hospice, or palliative care from 2011 to 2015. Four indicators of potentially inappropriate opioid prescribing were measured in patients residing in communities (75,258 patients with and 435,870 patients without ADRD); five indicators were assessed in patients in nursing homes (NHs) (37,117 patients with and 5128 patients without ADRD). Each indicator was calculated as the proportion of eligible patients with inappropriate opioid prescribing in the year after a chronic pain diagnosis. Differences in proportions between ADRD and non-ADRD groups were estimated using a generalized linear model adjusting for covariates through inverse probability weighting.ResultsPatients with ADRD versus those without had higher concurrent use of opioids and central nervous system–active drugs (community 44.1% vs 33.3%; NH 58.8% vs 54.1%, both P < 0.001) and no opioids or scheduled pain medications for moderate or severe pain (NH 60.1% vs 52.5%, P < 0.001). The ADRD versus non-ADRD group had higher use of long-term opioids for treating neuropathic pain in communities (21.7% vs 19.5%, P = 0.003) but lower use in NHs (26.9% vs 36.0%, P < 0.001). Use of strong or high-dose opioids when naive to opioids (community 1.5% vs 2.8%; NH 2.5% vs 3.5%) and use of contraindicated opioids (community 0.08% vs 0.12%; NH 0.05% vs 0.21%) were rare for either group.ConclusionPotential inappropriate opioid prescribing in 2 areas of pain care was more common among patients with ADRD than among patients without ADRD in community or NH settings. Further studies aimed at understanding the factors and effects associated with opioid prescribing patterns that deviate from guidelines are warranted.
Highlights
Pain is common among older adults with Alzheimer disease and related dementias (ADRD), with up to 60% of affected patients in communities and 80% of those in nursing homes (NHs) reporting regular pain [1]
Of 553,373 Medicare beneficiaries with chronic pain identified, 75,258 patients with ADRD and 435,870 patients without ADRD were living in communities (Table 2), and 37,117 patients with ADRD and 5128 patients without ADRD were residing in NHs (Table 3)
After IPW, distributions of all measured baseline characteristics were well balanced between ADRD and non-ADRD groups in all patient cohorts in communities and NHs (Supplement eTables 4 and 5), with standardized mean differences for characteristics less than 0.1 (Supplement eFigures 2 and 3)
Summary
Pain is common among older adults with Alzheimer disease and related dementias (ADRD), with up to 60% of affected patients in communities and 80% of those in nursing homes (NHs) reporting regular pain [1]. Findings of recent population-based studies, suggest that patients with ADRD were or more likely than patients without ADRD to receive analgesics for pain management [7,8,9,10]. The increasing analgesic use in patients with ADRD may result from increasing clinical awareness of the need for improved pain assessment and management in this patient population [7, 10]. Pain is common among individuals with Alzheimer’s disease and related dementias (ADRD), and use of opioids has been increasing over the last decade. The objective of this study is to compare the quality of opioid prescribing among patients with or without ADRD who have chronic noncancer pain
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
