Abstract
ObjectivesIdentifying factors associated with opioid use in middle-aged and older adults is a fundamental step in the mitigation of potentially unnecessary opioid consumption and opioid-related harms.MethodsUsing longitudinal data on a community-based cohort of adults aged 50–90 years residing in Johnston County, North Carolina, we examined sociodemographic and clinical factors in non-opioid users (n = 786) at baseline (2006–2010) as predictors of opioid use at follow-up (2013–2015). Variables included age, sex, race, obesity, educational attainment, employment status, household poverty rate, marital status, depressive symptoms, social support, pain catastrophizing, pain sensitivity, insurance status, polypharmacy, and smoking status.ResultsAt follow-up, 13% of participants were using prescription opioids. In the multivariable model, high pain catastrophizing (adjusted odds ratio; 95% confidence interval = 2.14; 1.33–3.46), polypharmacy (2.08; 1.23–3.53), and history of depressive symptoms (2.00; 1.19–3.38) were independent markers of opioid use.DiscussionFindings support the assessment of these modifiable factors during clinical encounters in patients ≥ 50 years old with chronic pain.
Highlights
IntroductionRepresenting a population that has a higher prevalence of chronic pain requiring treatment (Dahlhamer et al, 2018), older adults are vulnerable to certain opioid-related harms, such as falls, fractures, and unintentional overdose (Yoshikawa et al, 2020)
Opioid prescribing rates in the United States (US) reached a peak in 2010–2012, and despite declines in prescribing in the years since (Garcia et al, 2019; Guy et al, 2017), opioidrelated hospitalizations, emergency department visits, and mortality have been increasing among older adults (Weiss et al, 2018; Zullo et al, 2020)
Enrollment in the original Johnston County Osteoarthritis Project (JoCoOA) cohort was completed between 1991 and 1997 (T0) using probabilitybased sampling methods (described in detail elsewhere (Jordan et al, 2007)), which were designed to be representative of the Black and White civilian, non-institutionalized adults aged ≥ 45 years residing in Johnston County, regardless of osteoarthritis status (n = 3187); additional participants were enrolled during 2003–2004 (T1Ã; n = 1015) to enrich the cohort for Black and younger adults
Summary
Representing a population that has a higher prevalence of chronic pain requiring treatment (Dahlhamer et al, 2018), older adults are vulnerable to certain opioid-related harms, such as falls, fractures, and unintentional overdose (Yoshikawa et al, 2020). Assessments of other factors among older adults, including sociodemographics, non-opioid medication use, pain, comorbidities, and substance use, have found weak or varying associations with opioid-related outcomes (Zullo et al, 2020). These findings from previous studies were limited by Journal of Aging and Health 0(0)
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