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Beyene K, Fahmy H, Chan AHY, Tomlin A, Cheung G. Predictors of persistent opioid use in non-cancer older adults: a retrospective cohort study. Age Ageing 2023; 52:afad167. [PMID: 37659093 DOI: 10.1093/ageing/afad167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/19/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND Long-term opioid use and associated adverse outcomes have increased dramatically in recent years. Limited research is available on long-term opioid use in older adults. OBJECTIVE We aimed to determine the incidence and predictors of long-term or persistent opioid use (POU) amongst opioid-naïve older adults without a cancer diagnosis. METHODS This was a retrospective cohort study using five national administrative healthcare databases in New Zealand. We included all opioid-naïve older adults (≥65 years) who were initiated on opioid therapy between January 2013 and June 2018. The outcome of interest was POU, defined as having continuously filled ≥1 opioid prescription within 91-180 days after the index opioid prescription. Multivariable logistic regression was used to examine the predictors of POU. RESULTS The final sample included 268,857 opioid-naïve older adults; of these, 5,849(2.2%) developed POU. Several predictors of POU were identified. The use of fentanyl (adjusted odds ratio (AOR) = 3.61; 95% confidence interval (CI) 2.63-4.95), slow-release opioids (AOR = 3.02; 95%CI 2.78-3.29), strong opioids (AOR = 2.03; 95%CI 1.55-2.65), Charlson Comorbidity Score ≥ 3 (AOR = 2.09; 95% CI 1.78-2.46), history of substance abuse (AOR = 1.52; 95%CI 1.35-1.72), living in most socioeconomically deprived areas (AOR = 1.40; 95%CI 1.27-1.54), and anti-epileptics (AOR = 2.07; 95%CI 1.89-2.26), non-opioid analgesics (AOR = 2.05; 95%CI 1.89-2.21), antipsychotics (AOR = 1.96; 95%CI 1.78-2.17) or antidepressants (AOR = 1.50; 95%CI 1.41-1.59) medication use were the strongest predictors of POU. CONCLUSION A significant proportion of patients developed POU, and several factors were associated with POU. The findings will enable healthcare providers and policymakers to target early interventions to prevent POU and related adverse events.
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Affiliation(s)
- Kebede Beyene
- Department of Pharmaceutical and Administrative Sciences, University of Health Sciences and Pharmacy, St. Louis, MO, USA
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Hoda Fahmy
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Amy Hai Yan Chan
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Andrew Tomlin
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Gary Cheung
- Department of Psychological Medicine, School of Medicine, The University of Auckland, Auckland, New Zealand
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Perelló-Bratescu A, Dürsteler C, Álvarez-Carrera MA, Granés L, Kostov B, Sisó-Almirall A. Risk Prescriptions of Strong Opioids in the Treatment of Chronic Non-Cancer Pain by Primary Care Physicians in Catalonia: Opicat Padris Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031652. [PMID: 35162674 PMCID: PMC8834876 DOI: 10.3390/ijerph19031652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 02/04/2023]
Abstract
The prescription of strong opioids (SO) for chronic non-cancer pain (CNCP) is steadily increasing. This entails a high risk of adverse effects, a risk that increases with the concomitant prescription of SO with central nervous system depressant drugs and with the use of SO for non-recommended indications. In order to examine this concomitant risk prescription, we designed a descriptive, longitudinal, retrospective population-based study. Patients aged ≥15 years with a continued SO prescription for ≥3 months during 2013–2017 for CNCP were included. Of these, patients who had received concomitant prescriptions of SO and risk drugs (gabapentinoids, benzodiazepines and antidepressants) and those who had received immediate-release fentanyl (IRF) were selected. The study included 22,691 patients; 20,354 (89.7%) patients received concomitant risk prescriptions. Men and subjects with a higher socioeconomic status received fewer concomitant risk prescriptions. Benzodiazepines or Z-drugs were prescribed concomitantly with SO in 15,883 (70%) patients, antidepressants in 14,932 (65%) and gabapentinoids in 11,267 (49%), while 483 (21.32%) patients received IRF (2266 prescriptions in total) without a baseline SO. In conclusion, our study shows that a high percentage of patients prescribed SO for CNCP received concomitant prescriptions with known risks, as well as IRF for unauthorized indications.
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Affiliation(s)
- Aina Perelló-Bratescu
- Larrard Primary Health Center, Parc Sanitari Pere Virgili, 08024 Barcelona, Spain;
- Primary Healthcare Transversal Research Group, IDIBAPS, 08036 Barcelona, Spain;
| | - Christian Dürsteler
- Pain Medicine Section, Anaesthesiology Department, Hospital Clínic de Barcelona, 08036 Barcelona, Spain;
- Surgery Department, Medicine Faculty, Universitat de Barcelona, 08036 Barcelona, Spain
| | | | - Laura Granés
- Preventive Medicine and Epidemiology Department, Hospital Clinic Barcelona, 08036 Barcelona, Spain;
| | - Belchin Kostov
- Primary Healthcare Transversal Research Group, IDIBAPS, 08036 Barcelona, Spain;
- Primary Care Centre Les Corts, Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), 08028 Barcelona, Spain
| | - Antoni Sisó-Almirall
- Primary Healthcare Transversal Research Group, IDIBAPS, 08036 Barcelona, Spain;
- Primary Care Centre Les Corts, Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), 08028 Barcelona, Spain
- Medicine Department, Medicine Faculty, Universitat de Barcelona, 08036 Barcelona, Spain
- Correspondence:
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Shah R, Raji MA, Westra J, Kuo YF. Association of co-prescribing of opioid and benzodiazepine substitutes with incident falls and fractures among older adults: a cohort study. BMJ Open 2021; 11:e052057. [PMID: 35476819 PMCID: PMC8719209 DOI: 10.1136/bmjopen-2021-052057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 12/13/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Examine the association between the co-prescribing of opioids, benzodiazepines, gabapentinoids (pregabalin and gabapentin) and selective serotonin reuptake inhibitors/serotonin and norepinephrine reuptake inhibitors (SSRI/SNRIs) in different combinations and the risk of falls and fractures. DESIGN Retrospective cohort study from 2015 to 2018. SETTING Medicare enrolment and claims data. PARTICIPANTS Medicare beneficiaries with both chronic pain and anxiety disorders in 2016 with continuous enrolments in Parts A and B from 2015 to 2016 who were prescribed any combination of opioid, benzodiazepine, gabapentinoid and SSRI/SNRI in 2017 for ≥7 days, as documented in their Medicare Part D coverage. INTERVENTIONS Any combination of use of seven drug regimens (benzodiazepine +opioid; benzodiazepine +gabapentinoid; benzodiazepine +SSRI/SNRI; opioid +gabapentinoid; opioid +SSRI/SNRI; gabapentinoid +SSRI/SNRI; ≥3 drug classes). MAIN OUTCOMES First event of fall and the first event of fracture after the index date, which was the first day of combination drug use that lasted ≥7 days in 2017. RESULTS A total of 47 964 patients (mean [SD] age, 75.9 [7.1]; 78.0% woman) with diagnoses of both chronic pain and anxiety were studied. The median (Q1-Q3) duration of drug combination use was 26 (14-30) days. After adjusting for demographic characteristics, chronic conditions and history of hospitalisation and fall or fracture, the co-prescribing of ≥3 drugs (adjusted HR [aHR], 1.38; 95% CI 1.14 to 1.67) and opioid plus gabapentinoid (aHR, 1.18; 95% CI 1.02 to 1.37) were associated with a high fall risk, compared with benzodiazepineplus opioid co-prescribing, findings consistent with the secondary analysis using inverse probability of treatment weighting with propensity scores. The co-prescribing of benzodiazepine plus gabapentinoid (aHR, 0.76; 95% CI 0.59 to 0.98) was associated with lower fracture risk compared with the co-prescribing of benzodiazepine plus opioid, though this finding was not robust. CONCLUSIONS Our findings add to comparative toxicity research on different combinations of gabapentinoids and serotonergic agents commonly prescribed with or as substitutes for opioids and benzodiazepines in patients with co-occurring chronic pain and anxiety.
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Affiliation(s)
- Rahul Shah
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mukaila A Raji
- Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
- Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Jordan Westra
- Office of Biostatistics, Department of Preventive Medicine and Population Health, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Yong-Fang Kuo
- Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
- Department of Preventive Medicine and Population Health, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
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Neelamegam M, Zgibor J, Chen H, O’rourke K, Bakour C, Rajaram L, Anstey KJ. The effect of opioids on the cognitive function of older adults: results from the Personality and Total Health through life study. Age Ageing 2021; 50:1699-1708. [PMID: 33755047 PMCID: PMC8437064 DOI: 10.1093/ageing/afab048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND chronic pain, a common complaint among older adults, affects physical and mental well-being. While opioid use for pain management has increased over the years, pain management in older adults remains challenging, due to potential severe adverse effects of opioids in this population. OBJECTIVE we examined the association between opioid use, and changes in cognitive function of older adults. DESIGN prospective study. SETTING community dwelling older adults. SUBJECTS study population consisted of 2,222 individuals aged 65-69 years at baseline from the Personality and Total Health Through Life Study in Australia. METHODS medication data were obtained from the Pharmaceutical Benefits Scheme. Cognitive measures were obtained from neuropsychological battery assessment. Opioid exposure was quantified as Total Morphine Equivalent Dose (MED). The association between change in cognitive function between Wave 2 and Wave 3, and cumulative opioid use was assessed through generalized linear models. RESULTS cumulative opioid exposure exceeding total MED of 2,940 was significantly associated with poorer performance in the Mini Mental State Examination (MMSE). Compared with those not on opioids, individuals exposed to opioids resulting in cumulative total MED of greater than 2,940 had significantly lower scores in the MMSE (Model 1: β = -0.34, Model 2: β = -0.35 and Model 3: β = -0.39, P < 0.01). Performance in other cognitive assessments was not associated with opioid use. CONCLUSION prolonged opioid use in older adults can affect cognitive function, further encouraging the need for alternative pain management strategies in this population. Pain management options should not adversely affect healthy ageing trajectories and cognitive health.
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Affiliation(s)
- Malinee Neelamegam
- Yale School of Public Health, Yale University, New Haven, CT, USA
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Janice Zgibor
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Henian Chen
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Kathleen O’rourke
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Chighaf Bakour
- College of Public Health, University of South Florida, Tampa, FL, USA
| | | | - Kaarin J Anstey
- Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
- Neuroscience Research Australia, Sydney, Australia
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A meta-analysis of observational studies on anticholinergic burden and fracture risk: evaluation of conventional burden scales. J Pharm Health Care Sci 2021; 7:30. [PMID: 34465380 PMCID: PMC8408921 DOI: 10.1186/s40780-021-00213-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/10/2021] [Indexed: 11/29/2022] Open
Abstract
Background Anticholinergic burden potentially increases the risk of fracture. Although there are various anticholinergic burden scales, little is known about the inter-scale compatibility regarding the relationship of anticholinergic burden with fracture risk. We performed meta-analysis to examine the association of fracture risk with anticholinergic burden measured using various scales. Methods Primary literature was retrieved from PubMed (1966 to March, 2021), the Cochrane Library (1974 to March, 2021), Scopus (1970 to March, 2021), and Ichushi-web (1983 to March, 2021). Cohort and case-control studies that evaluated the association between any fracture and anticholinergic drugs were included. Additionally, we included studies in which patients were administered anticholinergic drugs included on the anticholinergic risk scale (ARS), anticholinergic cognitive burden (ACB), anticholinergic drug scale, or drug burden index-anticholinergic component. Random effects models were used to calculate pooled relative risk (RR) and 95% confidence interval (CI) due to heterogeneity among the studies. Publication bias was examined by funnel plots and the Begg’s test. Results A total of 49 datasets from 10 studies were included in the meta-analysis. Six of the 10 studies included only patients aged over 65 years, who accounted for 93% of the total study population (453,186/487,247). Meta-analysis indicated a positive relationship between use of anticholinergic drugs and fracture risk, regardless of the anticholinergic burden scale used. However, the relationship between anticholinergic burden and fracture risk varied depending on the scale used. Fracture risk increased linearly with increasing anticholinergic burden measured using ARS. ARS 1 point was associated with 28% increase in fracture risk, ARS 1–2 point(s) with 39%, ARS 2 points with 54%, ARS 3 points with 66%, and ARS ≥ 4 points with 77%. On the other hand, ACB 1 point and ACB 2 points were associated with similar fracture risk (pooled RR [95% CI]: overall; 1.28 [1.18–1.39], 1 point; 1.12 [1.06–1.18], 2 points; 1.15 [1.08–1.23]). Conclusions This result suggests that the relationship between anticholinergic drug burden and fracture risk may differ depending on the anticholinergic burden scale used. Supplementary Information The online version contains supplementary material available at 10.1186/s40780-021-00213-y.
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Yoshikawa A, Ramirez G, Smith ML, Foster M, Nabil AK, Jani SN, Ory MG. Opioid Use and the Risk of Falls, Fall Injuries and Fractures among Older Adults: A Systematic Review and Meta-Analysis. J Gerontol A Biol Sci Med Sci 2021; 75:1989-1995. [PMID: 32016284 DOI: 10.1093/gerona/glaa038] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is increasing concern about opioid use as a pain treatment option among older adults. Existing literature implies an association between opioid use and fracture, increasing the risk of death and disabilities; yet, this relationship with other fall-related outcomes has not been fully explored. We performed a meta-analysis to evaluate the associations between opioid use and adverse health outcomes of falls, fall injuries, and fractures among older adults. METHODS A systematic literature search was conducted using nine databases: Medline, Embase, CINAHL, PsycInfo, Global Health, Northern Light Sciences Conference Abstracts, Cochrane CENTRAL, WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov. We log-transformed effect sizes (relative risk [RR], odds ratio [OR], and hazard ratio [HR]) to compute pooled risk estimates comparable across the studies. The random-effects model was applied to calculate the pooled risk estimates due to heterogeneity. Meta-regressions explored differences in risk estimates by analysis method, study design, setting, and study quality. RESULTS Thirty studies, providing 34 relevant effect sizes, met the inclusion criteria for this meta-analysis. Overall, opioid use was significantly associated with falls, fall injuries, and fractures, with effect sizes ranging from 0.15 to 0.71. In meta-regressions, no selected factors explained heterogeneity. CONCLUSION While heterogeneity is present, results suggest an increased risk of falls, fall injuries, and fractures among older adults who used opioids. Findings highlight the need for opioid education and nonopioid-related pain management interventions among older adults to decrease fall-related risk.
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Affiliation(s)
- Aya Yoshikawa
- Center for Population Health and Aging, Texas A&M University, College Station
| | - Gilbert Ramirez
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station
| | - Matthew Lee Smith
- Center for Population Health and Aging, Texas A&M University, College Station.,Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station.,Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens
| | - Margaret Foster
- Medical Sciences Library, Texas A&M University, College Station
| | - Anas K Nabil
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station
| | - Sagar N Jani
- Center for Population Health and Aging, Texas A&M University, College Station.,Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station
| | - Marcia G Ory
- Center for Population Health and Aging, Texas A&M University, College Station.,Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station
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7
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O'Brien MDC, Wand APF. A systematic review of the evidence for the efficacy of opioids for chronic non-cancer pain in community-dwelling older adults. Age Ageing 2020; 49:175-183. [PMID: 31971548 DOI: 10.1093/ageing/afz175] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION the ageing global population and concomitant increase in the use of opioid analgesia have highlighted the need to evaluate the effectiveness of opioids for chronic pain in older people. METHODS a systematic review of the evidence for the efficacy of opioids for chronic non-cancer pain in community-dwelling people aged 65 years or more was conducted using PRISMA guidelines. The databases MEDLINE, EMBASE, Pubmed and PsychINFO were searched. The quality of studies was assessed. Secondary aims were to assess correlates of opioid use and the decision-making processes of prescribers. RESULTS seven studies were identified of low to high quality. The majority of older people experienced ongoing pain despite continuing opioid therapy. There were mixed results regarding benefits of opioids in terms of activities of daily living and social engagement. In nursing home residents, opioid use at baseline was associated with severe pain, severe impairment in activities of daily living and a diagnosis of depression. Fear of causing harm to older people was common amongst opioid prescribers, limiting prescription. Facilitators of opioid prescription included educational interventions and access to an evidence base for opioid use. CONCLUSION there is limited evidence supporting the use of long-term opioid use in older people for chronic non-cancer pain and a lack of trials in this age group. Age-specific guidelines are required addressing initial assessment, indications, monitoring and de-prescribing.
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Affiliation(s)
- Michael David Cory O'Brien
- Geriatric and Rehabilitation Services, Royal Brisbane and Women's Hospital, Butterfield Street Herston, Queensland, Australia.,School of Medicine, University of Notre Dame, Sydney, Australia
| | - Anne Pamela Frances Wand
- Older Persons' Mental Health Service, Euroa Centre, Prince of Wales Hospital, Barker Street, Randwick, New South Wales, Australia.,School of Psychiatry, University of New South Wales, Sydney, Australia
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8
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Peng LN, Chou YJ, Chen LK, Huang N. Post-acute Use of Opioids and Psychotropics in Patients after Hip Fracture: Unintended Consequences of Implementing Diagnosis-Related Grouping Payment. J Nutr Health Aging 2020; 24:745-751. [PMID: 32744571 DOI: 10.1007/s12603-020-1383-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE How implementing diagnostic-related grouping (DRG) payment affected the use of opioids and psychotropics by hip fracture patients following hospitalization remained unknown. DESIGN A retrospective, pre-post design, cohort study of data excerpted from Taiwan's National Health Insurance Research database (NHIRD). SETTING AND PARTICIPANTS Adults aged ≥ 65 years first admitted for hip fracture surgery from 2007 to 2012 were identified and divided into two 1:1 propensity-score matched groups: pre-DRG (2007-2009); DRG (2010-2012). MEASUREMENTS The outcome measures were use of opioid and/or psychotropic drugs within 30 days, 90 days, 180 days, and 365 days after discharge. RESULTS Data of 16,522 subjects were excerpted, and 8,261 propensity-score matched subjects each classified into the pre-DRG and DRG groups. After adjustment, the DRG group was significantly more likely than the pre-DRG group to have used antipsychotics after discharge from hip fracture surgery (≤30 days, ≤90 days, ≤180 days and ≤365 days). The DRG group also had significantly higher prescription rates of benzodiazepines and antipsychotics during the observation period. Moreover, the DRG group was less likely to use non-steroidal anti-inflammatory drugs (≤30 days, ≤90 days, ≤180 days and ≤365 days) and more likely to use acetaminophen (≤30 days, ≤180 days, and ≤365 days). CONCLUSIONS In conclusion, DRG implementation in Taiwan substantially increased post-acute prescription of antipsychotic and psychotropic agents for hip fracture patients, and changed use of analgesics, which may result in suboptimal quality and safety for these patients. Further research is needed to evaluate the long-term outcomes of DRG implementation, and the potential benefits of appropriate post-acute care bundled with DRG payment.
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Affiliation(s)
- L-N Peng
- Prof. Nicole Huang, Institute of Public Health, National Yang Ming University, No. 155, Sec. 2, Linong St., Taipei 11221, Taiwan,
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Daoust R, Paquet J, Moore L, Émond M, Gosselin S, Lavigne G, Choinière M, Boulanger A, Mac-Thiong JM, Chauny JM. Recent opioid use and fall-related injury among older patients with trauma. CMAJ 2019; 190:E500-E506. [PMID: 29685910 DOI: 10.1503/cmaj.171286] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Evidence for an association between opioid use and risk of falls or fractures in older adults is inconsistent. We examine the association between recent opioid use and the risk, as well as the clinical outcomes, of fall-related injuries in a large trauma population of older adults. METHODS In a retrospective, observational, multicentre cohort study conducted on registry data, we included all patients aged 65 years and older who were admitted (hospital stay > 2 d) for injury in 57 trauma centres in the province of Quebec, Canada, between 2004 and 2014. We looked at opioid prescriptions filled in the 2 weeks preceding the trauma in patients who sustained a fall, compared with those who sustained an injury through another mechanism. RESULTS A total of 67 929 patients were retained for analysis. Mean age was 80.9 (± 8.0) years and 69% were women. The percentage of patients who had filled an opioid prescription in the 2 weeks preceding an injury was 4.9% (95% confidence interval [CI] 4.7%-5.1%) for patients who had had a fall, compared with 1.5% (95% CI 1.2%-1.8%) for those who had had an injury through another mechanism. After we controlled for confounding variables, patients who had filled an opioid prescription within 2 weeks before injury were 2.4 times more likely to have a fall rather than any other type of injury. For patients who had a fall-related injury, those who used opioids were at increased risk of in-hospital death (odds ratio 1.58; 95% CI 1.34-1.86). INTERPRETATION Recent opioid use is associated with an increased risk of fall and an increased likelihood of death in older adults.
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Affiliation(s)
- Raoul Daoust
- Department of Emergency Medicine (Daoust, Paquet, Chauny), Research Centre, Hôpital du Sacré-Coeur de Montréal; Faculté de Médecine (Daoust, Mac-Thiong, Chauny), Université de Montréal; Montréal, Que.; Département de médecine sociale et préventive (Moore), Faculté de médecine, Université Laval; Axe de recherche en traumatologie-urgence-soins intensifs du Centre de recherche FRQS du CHU-Québec (Moore); Département de médecine familiale et de médecine d'urgence (Émond), Faculté de médecine, Université Laval, Québec, Que.; Department of Emergency Medicine (Gosselin), McGill University Health Centre, McGill University; Faculties of Dental Medicine and Medicine (Lavigne), Université de Montréal; Center for Advanced Research in Sleep Medicine (Lavigne), Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal); Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) (Choinière, Boulanger); Département d'anesthésiologie (Choinière), Faculté de médecine, Université de Montréal; Research Centre (Daoust, Paquet, Mac-Thiong, Chauny), Hôpital du Sacré-Coeur (CIUSSS du Nord de-l'Île-de-Montréal), Montréal, Que.
| | - Jean Paquet
- Department of Emergency Medicine (Daoust, Paquet, Chauny), Research Centre, Hôpital du Sacré-Coeur de Montréal; Faculté de Médecine (Daoust, Mac-Thiong, Chauny), Université de Montréal; Montréal, Que.; Département de médecine sociale et préventive (Moore), Faculté de médecine, Université Laval; Axe de recherche en traumatologie-urgence-soins intensifs du Centre de recherche FRQS du CHU-Québec (Moore); Département de médecine familiale et de médecine d'urgence (Émond), Faculté de médecine, Université Laval, Québec, Que.; Department of Emergency Medicine (Gosselin), McGill University Health Centre, McGill University; Faculties of Dental Medicine and Medicine (Lavigne), Université de Montréal; Center for Advanced Research in Sleep Medicine (Lavigne), Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal); Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) (Choinière, Boulanger); Département d'anesthésiologie (Choinière), Faculté de médecine, Université de Montréal; Research Centre (Daoust, Paquet, Mac-Thiong, Chauny), Hôpital du Sacré-Coeur (CIUSSS du Nord de-l'Île-de-Montréal), Montréal, Que
| | - Lynne Moore
- Department of Emergency Medicine (Daoust, Paquet, Chauny), Research Centre, Hôpital du Sacré-Coeur de Montréal; Faculté de Médecine (Daoust, Mac-Thiong, Chauny), Université de Montréal; Montréal, Que.; Département de médecine sociale et préventive (Moore), Faculté de médecine, Université Laval; Axe de recherche en traumatologie-urgence-soins intensifs du Centre de recherche FRQS du CHU-Québec (Moore); Département de médecine familiale et de médecine d'urgence (Émond), Faculté de médecine, Université Laval, Québec, Que.; Department of Emergency Medicine (Gosselin), McGill University Health Centre, McGill University; Faculties of Dental Medicine and Medicine (Lavigne), Université de Montréal; Center for Advanced Research in Sleep Medicine (Lavigne), Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal); Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) (Choinière, Boulanger); Département d'anesthésiologie (Choinière), Faculté de médecine, Université de Montréal; Research Centre (Daoust, Paquet, Mac-Thiong, Chauny), Hôpital du Sacré-Coeur (CIUSSS du Nord de-l'Île-de-Montréal), Montréal, Que
| | - Marcel Émond
- Department of Emergency Medicine (Daoust, Paquet, Chauny), Research Centre, Hôpital du Sacré-Coeur de Montréal; Faculté de Médecine (Daoust, Mac-Thiong, Chauny), Université de Montréal; Montréal, Que.; Département de médecine sociale et préventive (Moore), Faculté de médecine, Université Laval; Axe de recherche en traumatologie-urgence-soins intensifs du Centre de recherche FRQS du CHU-Québec (Moore); Département de médecine familiale et de médecine d'urgence (Émond), Faculté de médecine, Université Laval, Québec, Que.; Department of Emergency Medicine (Gosselin), McGill University Health Centre, McGill University; Faculties of Dental Medicine and Medicine (Lavigne), Université de Montréal; Center for Advanced Research in Sleep Medicine (Lavigne), Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal); Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) (Choinière, Boulanger); Département d'anesthésiologie (Choinière), Faculté de médecine, Université de Montréal; Research Centre (Daoust, Paquet, Mac-Thiong, Chauny), Hôpital du Sacré-Coeur (CIUSSS du Nord de-l'Île-de-Montréal), Montréal, Que
| | - Sophie Gosselin
- Department of Emergency Medicine (Daoust, Paquet, Chauny), Research Centre, Hôpital du Sacré-Coeur de Montréal; Faculté de Médecine (Daoust, Mac-Thiong, Chauny), Université de Montréal; Montréal, Que.; Département de médecine sociale et préventive (Moore), Faculté de médecine, Université Laval; Axe de recherche en traumatologie-urgence-soins intensifs du Centre de recherche FRQS du CHU-Québec (Moore); Département de médecine familiale et de médecine d'urgence (Émond), Faculté de médecine, Université Laval, Québec, Que.; Department of Emergency Medicine (Gosselin), McGill University Health Centre, McGill University; Faculties of Dental Medicine and Medicine (Lavigne), Université de Montréal; Center for Advanced Research in Sleep Medicine (Lavigne), Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal); Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) (Choinière, Boulanger); Département d'anesthésiologie (Choinière), Faculté de médecine, Université de Montréal; Research Centre (Daoust, Paquet, Mac-Thiong, Chauny), Hôpital du Sacré-Coeur (CIUSSS du Nord de-l'Île-de-Montréal), Montréal, Que
| | - Gilles Lavigne
- Department of Emergency Medicine (Daoust, Paquet, Chauny), Research Centre, Hôpital du Sacré-Coeur de Montréal; Faculté de Médecine (Daoust, Mac-Thiong, Chauny), Université de Montréal; Montréal, Que.; Département de médecine sociale et préventive (Moore), Faculté de médecine, Université Laval; Axe de recherche en traumatologie-urgence-soins intensifs du Centre de recherche FRQS du CHU-Québec (Moore); Département de médecine familiale et de médecine d'urgence (Émond), Faculté de médecine, Université Laval, Québec, Que.; Department of Emergency Medicine (Gosselin), McGill University Health Centre, McGill University; Faculties of Dental Medicine and Medicine (Lavigne), Université de Montréal; Center for Advanced Research in Sleep Medicine (Lavigne), Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal); Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) (Choinière, Boulanger); Département d'anesthésiologie (Choinière), Faculté de médecine, Université de Montréal; Research Centre (Daoust, Paquet, Mac-Thiong, Chauny), Hôpital du Sacré-Coeur (CIUSSS du Nord de-l'Île-de-Montréal), Montréal, Que
| | - Manon Choinière
- Department of Emergency Medicine (Daoust, Paquet, Chauny), Research Centre, Hôpital du Sacré-Coeur de Montréal; Faculté de Médecine (Daoust, Mac-Thiong, Chauny), Université de Montréal; Montréal, Que.; Département de médecine sociale et préventive (Moore), Faculté de médecine, Université Laval; Axe de recherche en traumatologie-urgence-soins intensifs du Centre de recherche FRQS du CHU-Québec (Moore); Département de médecine familiale et de médecine d'urgence (Émond), Faculté de médecine, Université Laval, Québec, Que.; Department of Emergency Medicine (Gosselin), McGill University Health Centre, McGill University; Faculties of Dental Medicine and Medicine (Lavigne), Université de Montréal; Center for Advanced Research in Sleep Medicine (Lavigne), Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal); Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) (Choinière, Boulanger); Département d'anesthésiologie (Choinière), Faculté de médecine, Université de Montréal; Research Centre (Daoust, Paquet, Mac-Thiong, Chauny), Hôpital du Sacré-Coeur (CIUSSS du Nord de-l'Île-de-Montréal), Montréal, Que
| | - Aline Boulanger
- Department of Emergency Medicine (Daoust, Paquet, Chauny), Research Centre, Hôpital du Sacré-Coeur de Montréal; Faculté de Médecine (Daoust, Mac-Thiong, Chauny), Université de Montréal; Montréal, Que.; Département de médecine sociale et préventive (Moore), Faculté de médecine, Université Laval; Axe de recherche en traumatologie-urgence-soins intensifs du Centre de recherche FRQS du CHU-Québec (Moore); Département de médecine familiale et de médecine d'urgence (Émond), Faculté de médecine, Université Laval, Québec, Que.; Department of Emergency Medicine (Gosselin), McGill University Health Centre, McGill University; Faculties of Dental Medicine and Medicine (Lavigne), Université de Montréal; Center for Advanced Research in Sleep Medicine (Lavigne), Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal); Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) (Choinière, Boulanger); Département d'anesthésiologie (Choinière), Faculté de médecine, Université de Montréal; Research Centre (Daoust, Paquet, Mac-Thiong, Chauny), Hôpital du Sacré-Coeur (CIUSSS du Nord de-l'Île-de-Montréal), Montréal, Que
| | - Jean-Marc Mac-Thiong
- Department of Emergency Medicine (Daoust, Paquet, Chauny), Research Centre, Hôpital du Sacré-Coeur de Montréal; Faculté de Médecine (Daoust, Mac-Thiong, Chauny), Université de Montréal; Montréal, Que.; Département de médecine sociale et préventive (Moore), Faculté de médecine, Université Laval; Axe de recherche en traumatologie-urgence-soins intensifs du Centre de recherche FRQS du CHU-Québec (Moore); Département de médecine familiale et de médecine d'urgence (Émond), Faculté de médecine, Université Laval, Québec, Que.; Department of Emergency Medicine (Gosselin), McGill University Health Centre, McGill University; Faculties of Dental Medicine and Medicine (Lavigne), Université de Montréal; Center for Advanced Research in Sleep Medicine (Lavigne), Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal); Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) (Choinière, Boulanger); Département d'anesthésiologie (Choinière), Faculté de médecine, Université de Montréal; Research Centre (Daoust, Paquet, Mac-Thiong, Chauny), Hôpital du Sacré-Coeur (CIUSSS du Nord de-l'Île-de-Montréal), Montréal, Que
| | - Jean-Marc Chauny
- Department of Emergency Medicine (Daoust, Paquet, Chauny), Research Centre, Hôpital du Sacré-Coeur de Montréal; Faculté de Médecine (Daoust, Mac-Thiong, Chauny), Université de Montréal; Montréal, Que.; Département de médecine sociale et préventive (Moore), Faculté de médecine, Université Laval; Axe de recherche en traumatologie-urgence-soins intensifs du Centre de recherche FRQS du CHU-Québec (Moore); Département de médecine familiale et de médecine d'urgence (Émond), Faculté de médecine, Université Laval, Québec, Que.; Department of Emergency Medicine (Gosselin), McGill University Health Centre, McGill University; Faculties of Dental Medicine and Medicine (Lavigne), Université de Montréal; Center for Advanced Research in Sleep Medicine (Lavigne), Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal); Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) (Choinière, Boulanger); Département d'anesthésiologie (Choinière), Faculté de médecine, Université de Montréal; Research Centre (Daoust, Paquet, Mac-Thiong, Chauny), Hôpital du Sacré-Coeur (CIUSSS du Nord de-l'Île-de-Montréal), Montréal, Que
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10
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Schwarzer A, Kaisler M, Kipping K, Seybold D, Rausch V, Maier C, Vollert J. Opioid intake prior to admission is not increased in elderly patients with low-energy fractures: A case-control study in a German hospital population. Eur J Pain 2018; 22:1651-1661. [PMID: 29758586 DOI: 10.1002/ejp.1247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Recent studies revealed an increased prescription rate of opioids for elderly patients suffering bone fractures. To gain further insight, we conducted face-to-face interviews in the present study to compare the opioid intake between patients with low-energy fractures and patients suffering from internal diseases. METHODS In this case-control study, 992 patients, aged 60 years and older, were enrolled between March 2014 and February 2015. The interview comprised a fall and medication history, comorbidities, mobility and other risk factors for fractures. Odds ratios (OR) and a multiple logistic regression model were calculated. RESULTS The number of patients with pre-admission opioid intake in the last 12 months was comparable in the fracture (n = 399, 13.3%) and the control group (n = 593, 14.7% OR: 0.89, CI: 0.62-1.29). The number of patients with current opioid intake of short duration (<3 months) was similar in both groups (14% vs. 20%; OR: 0.66, CI: 0.23-1.93). Patients with opioid intake in the fracture group reported more frequently fatigue as an adverse event of opioid medication (58% vs. 30%; OR: 3.32, CI: 1.48-7.45). Patients with opioid intake showed more severe comorbidities and significantly decreased mobility compared to those without opioids. CONCLUSION Elderly patients internalized due to low-energy fractures did not take opioids more frequently than patients with internal admission, for both short (<3 months) and longer duration intake. Patients with opioid intake were generally in poorer physical condition. The risk of fracture might increase in patients suffering from fatigue as a side effect of opioid medication. SIGNIFICANCE This study is based on face-to-face interviews with patients, including details about side effects and fracture history, providing a more pronounced picture of the relation of opioid intake and risk of fracture.
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Affiliation(s)
- A Schwarzer
- Department of Pain Medicine, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - M Kaisler
- Department of Pain Medicine, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - K Kipping
- Department of Pain Medicine, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - D Seybold
- Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - V Rausch
- Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - C Maier
- Department of Pain Medicine, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - J Vollert
- Department of Pain Medicine, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Germany.,Pain Research, Department of Surgery and Cancer, Imperial College London, UK.,Medical Faculty Mannheim, Center of Biomedicine and Medical Technology Mannheim CBTM, Heidelberg University, Germany
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11
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Hargrove JL, Golightly YM, Pate V, Casteel CH, Loehr LR, Marshall SW, Stürmer T. Initiation of antihypertensive monotherapy and incident fractures among Medicare beneficiaries. Inj Epidemiol 2017; 4:27. [PMID: 29043521 PMCID: PMC5645300 DOI: 10.1186/s40621-017-0125-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 10/04/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Research suggests antihypertensive medications are associated with fractures in older adults, however results are inconsistent and few have examined how the association varies over time. We sought to examine the association between antihypertensive class and incident non-vertebral fractures among older adults initiating monotherapy according to time since initiation. METHODS We used a new-user cohort design to identify Medicare beneficiaries (≥ 65 years of age) initiating antihypertensive monotherapy during 2008-2011 using a 20% random sample of Fee-For-Service Medicare beneficiaries enrolled in parts A (inpatient services), B (outpatient services), and D (prescription medication) coverage. Starting the day after the initial antihypertensive prescription, we followed beneficiaries for incident non-vertebral fractures. We used multinomial logistic regression models to estimate propensity scores for initiating each antihypertensive drug class. Using these propensity scores, we weighted beneficiaries to achieve the same baseline covariate distribution as beneficiaries initiating with angiotensin-converting enzyme inhibitors. Lastly, we used weighted Cox proportional hazard models to estimate hazard ratios (HRs) of having an incident fractures according to antihypertensive class and time since initiation. RESULTS During 2008-2011, 122,629 Medicare beneficiaries initiated antihypertensive monotherapy (mean age 75, 61% women, 86% White). Fracture rates varied according to days since initiation and antihypertensive class. Beneficiaries initiating with thiazides had the highest fracture rate in the first 14 days following initiation (438 per 10,000 person-years, 95% confidence interval (CI): 294-628; HR: 1.40, 0.78-2.52). However, beneficiaries initiating with calcium channel blockers had the highest fracture rate during the 15-365 days after initiation (435 per 10,000 person-years, 95% CI: 404-468; HR: 1.11, 1.00-1.24). Beneficiaries initiating with angiotensin-receptor blockers had the lowest fracture rates during the initial 14 days (333 per 10,000 person-years, 190-546, HR: 0.92, 0.49-1.75) and during 15-365 days after initiation (321 per 10,000 person-years, 287-358, HR: 0.96, 0.84-1.09). CONCLUSION The association between antihypertensives and fractures varied according to class and time since initiation. Results suggest that when deciding upon antihypertensive therapy, clinicians may want to consider possible fracture risks when choosing between antihypertensive drug classes.
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Affiliation(s)
- Jennifer L Hargrove
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Yvonne M Golightly
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Virginia Pate
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carri H Casteel
- College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Laura R Loehr
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephen W Marshall
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Til Stürmer
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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12
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Homer ML, Palmer NP, Fox KP, Armstrong J, Mandl KD. Predicting Falls in People Aged 65 Years and Older from Insurance Claims. Am J Med 2017; 130:744.e17-744.e23. [PMID: 28111165 PMCID: PMC5441951 DOI: 10.1016/j.amjmed.2017.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 12/30/2016] [Accepted: 01/02/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Accidental falls among people aged 65 years and older caused approximately 2,700,000 injuries, 27,000 deaths, and cost more than 34 billion dollars in the US annually in recent years. Here, we derive and validate a predictive model for falls based on a retrospective cohort of those 65 years and older. METHODS Insurance claims from a 1-year observational period were used to predict a fall-related claim in the following 2 years. The predictive model takes into account a person's age, sex, prescriptions, and diagnoses. Through random assignment, half of the people had their claims used to derive the model, while the remaining people had their claims used to validate the model. RESULTS Of 120,881 individuals with Aetna health insurance coverage, 12,431 (10.3%) members fell. During validation, people were risk stratified across 20 levels, where those in the highest risk stratum had 10.5 times the risk as those in the lowest stratum (33.1% vs 3.1%). CONCLUSIONS Using only insurance claims, individuals in this large cohort at high risk of falls could be readily identified up to 2 years in advance. Although external validation is needed, the findings support the use of the model to better target interventions.
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Affiliation(s)
- Mark L Homer
- Computational Health Informatics Program, Boston Children's Hospital, Boston, Mass; Department of Biomedical Informatics, Harvard Medical School, Boston, Mass
| | - Nathan P Palmer
- Computational Health Informatics Program, Boston Children's Hospital, Boston, Mass; Department of Biomedical Informatics, Harvard Medical School, Boston, Mass
| | | | | | - Kenneth D Mandl
- Computational Health Informatics Program, Boston Children's Hospital, Boston, Mass; Department of Biomedical Informatics, Harvard Medical School, Boston, Mass.
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13
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Mathew N, Rosenheck RA. Prescription Opioid Use Among Seriously Mentally Ill Veterans Nationally in the Veterans Health Administration. Community Ment Health J 2016; 52:165-73. [PMID: 26374435 DOI: 10.1007/s10597-015-9939-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 09/07/2015] [Indexed: 11/26/2022]
Abstract
Frequent prescription opioid use has been recognized as a growing problem but there have been no studies specifically among veterans with serious mental illness (SMI). National data from the Veterans Health Administration (VHA) during Fiscal Year 2012 show that VHA patients with SMI receive more opioid prescriptions than other veterans. Additionally, high numbers of opioid prescriptions is associated with greater use of anxiolytics/sedative-hypnotics, drug dependence and COPD-all of which pose an increased risk of respiratory depression and falls and warrant substantial caution and improved coordination between mental health and non-mental health prescribers to evaluate risk-benefit tradeoffs.
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Affiliation(s)
- Nickie Mathew
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
- VA Connecticut Healthcare System, West Haven, CT, USA.
| | - Robert A Rosenheck
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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14
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Anticholinergic Medication Use and Fractures in Postmenopausal Women: Findings from the Women’s Health Initiative. Drugs Aging 2015; 32:755-63. [DOI: 10.1007/s40266-015-0298-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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15
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Richardson K, Bennett K, Maidment ID, Fox C, Smithard D, Kenny RA. Use of Medications with Anticholinergic Activity and Self-Reported Injurious Falls in Older Community-Dwelling Adults. J Am Geriatr Soc 2015. [DOI: 10.1111/jgs.13543] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kathryn Richardson
- Department of Medical Gerontology; Trinity College Dublin; Dublin Ireland
- School of Health Sciences; Faculty of Medicine and Health Sciences; University of East Anglia; Norwich UK
| | - Kathleen Bennett
- Department of Pharmacology and Therapeutics; Trinity Centre for Health Sciences; St. James' Hospital; Dublin Ireland
| | - Ian D. Maidment
- School of Life and Health Sciences; University of Aston; Birmingham UK
- Aston Research Centre for Healthy Ageing; University of Aston; Birmingham UK
| | - Chris Fox
- Norwich Medical School; Faculty of Medicine and Health Sciences; University of East Anglia; Norwich UK
| | - David Smithard
- Princess Royal University Hospital; King's College National Health Service Foundation Trust; London UK
- Department of Digital Arts and Electronics; University of Kent; Canterbury UK
| | - Rose Anne Kenny
- Department of Medical Gerontology; Trinity College Dublin; Dublin Ireland
- Trinity College Institute of Neuroscience; St. James' Hospital; Dublin Ireland
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16
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Barry DT, Sofuoglu M, Kerns RD, Wiechers IR, Rosenheck RA. Prevalence and correlates of co-prescribing psychotropic medications with long-term opioid use nationally in the Veterans Health Administration. Psychiatry Res 2015; 227:324-32. [PMID: 25863822 DOI: 10.1016/j.psychres.2015.03.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 01/12/2015] [Accepted: 03/06/2015] [Indexed: 10/23/2022]
Abstract
We used national data for fiscal year 2012 to examine demographic, psychiatric and medical diagnoses, indications for psychotropics, and service use correlates of psychotropic medication fills in Veterans with at least 10 opioid prescriptions during the year (the highest 29% of opioid users); and whether the Veteran was treated in a specialty mental health clinic. Of the 328,398 Veterans who filled at least 10 opioid prescriptions, 77% also received psychotropics, of whom: 74% received antidepressants, 55% anxiolytics/sedatives/hypnotics, and 26% three or more classes of psychotropic medications. Altogether, 87% had a psychiatric or medical indication; and 54% received mental health treatment. Veterans treated in a mental health clinic were prescribed more psychotropics and were more likely to have a documented psychiatric or medical indication than those treated solely in other settings. Indicated psychiatric diagnoses were the strongest predictors of specific class of psychotropics prescribed; anxiety disorder and insomnia were most strongly associated with anxioloytics/sedatives/hypnotics receipt. Since psychotropics and opioids can produce harmful side effects, especially when combined, and since they are likely prescribed by separate providers in different settings, coordinated consideration of the risks and benefits of co-prescribing these medications may be needed, along with further study of related adverse events.
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Affiliation(s)
- Declan T Barry
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; APT Foundation Pain Treatment Services, New Haven, CT, USA
| | - Mehmet Sofuoglu
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Veterans Health Administration Mental Illness Research, Education and Clinical Center (MIRECC), West Haven, CT, USA
| | - Robert D Kerns
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA
| | - Ilse R Wiechers
- VA Connecticut Healthcare System, West Haven, CT, USA; Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, CT, USA
| | - Robert A Rosenheck
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Veterans Health Administration Mental Illness Research, Education and Clinical Center (MIRECC), West Haven, CT, USA
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17
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Correll CU, Detraux J, De Lepeleire J, De Hert M. Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder. World Psychiatry 2015; 14:119-36. [PMID: 26043321 PMCID: PMC4471960 DOI: 10.1002/wps.20204] [Citation(s) in RCA: 512] [Impact Index Per Article: 56.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
People with severe mental illness have a considerably shorter lifespan than the general population. This excess mortality is mainly due to physical illness. Next to mental illness-related factors, unhealthy lifestyle, and disparities in health care access and utilization, psychotropic medications can contribute to the risk of physical morbidity and mortality. We systematically reviewed the effects of antipsychotics, antidepressants and mood stabilizers on physical health outcomes in people with schizophrenia, depression and bipolar disorder. Updating and expanding our prior systematic review published in this journal, we searched MEDLINE (November 2009 - November 2014), combining the MeSH terms of major physical disease categories (and/or relevant diseases within these categories) with schizophrenia, major depressive disorder and bipolar disorder, and the three major psychotropic classes which received regulatory approval for these disorders, i.e., antipsychotics, antidepressants and mood stabilizers. We gave precedence to results from (systematic) reviews and meta-analyses wherever possible. Antipsychotics, and to a more restricted degree antidepressants and mood stabilizers, are associated with an increased risk for several physical diseases, including obesity, dyslipidemia, diabetes mellitus, thyroid disorders, hyponatremia; cardiovascular, respiratory tract, gastrointestinal, haematological, musculoskeletal and renal diseases, as well as movement and seizure disorders. Higher dosages, polypharmacy, and treatment of vulnerable (e.g., old or young) individuals are associated with greater absolute (elderly) and relative (youth) risk for most of these physical diseases. To what degree medication-specific and patient-specific risk factors interact, and how adverse outcomes can be minimized, allowing patients to derive maximum benefits from these medications, requires adequate clinical attention and further research.
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Affiliation(s)
- Christoph U Correll
- Department of Psychiatry, Zucker Hillside Hospital, North Shore - Long Island Jewish Health SystemGlen Oaks, New York, NY, USA,Department of Psychiatry and Molecular Medicine, Hofstra North Shore LIJ School of MedicineHempstead, New York, NY, USA,Psychiatric Neuroscience Center of Excellence, Feinstein Institute for Medical ResearchManhasset, New York, NY, USA,Department of Psychiatry and Behavioral Sciences, Albert Einstein College of MedicineBronx, New York, NY, USA
| | - Johan Detraux
- Department of Neurosciences, Catholic University LeuvenB-3070 Kortenberg, Belgium
| | - Jan De Lepeleire
- Department of Public Health and Primary Care, University of LeuvenB-3000 Leuven, Belgium
| | - Marc De Hert
- Department of Neurosciences, Catholic University LeuvenB-3070 Kortenberg, Belgium
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18
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Pickering ME, Chapurlat R, Kocher L, Peter-Derex L. Sleep Disturbances and Osteoarthritis. Pain Pract 2015; 16:237-44. [PMID: 25639339 DOI: 10.1111/papr.12271] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 10/06/2014] [Accepted: 11/02/2014] [Indexed: 02/06/2023]
Abstract
Sleep disturbances are particularly troublesome in patients with painful rheumatic disease. This article reviews the literature specifically published on sleep disturbances in osteoarthritis, a prevalent pathology and leading cause of disability. Several aspects of the relationship between sleep and osteoarthritis are discussed, including epidemiology, pathophysiological hypotheses, and treatment outcomes. Sleep is of central importance in the well-being of patients and should systematically be assessed in patients with osteoarthritis. When needed, a specific treatment of sleep disorders should be associated with an optimal management of pain to achieve synergistic improvements in quality of life. More large-scale studies are needed to identify predictive factors of sleep impairment in osteoarthritis.
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Affiliation(s)
| | - Roland Chapurlat
- Rheumatology Department, Hôpital E Herriot, Lyon, France.,Clinical Research, INSERM UMR 1033, Lyon, France.,University Lyon 1, Lyon, France
| | - Laurence Kocher
- Neurology and Sleep Department, Hôpital Lyon Sud, Lyon, France
| | - Laure Peter-Derex
- University Lyon 1, Lyon, France.,Neurology and Sleep Department, Hôpital Lyon Sud, Lyon, France.,"Neuropain" Team, INSERM U1028/5292, Centre de Recherche en Neurosciences, Lyon, France
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Webster LR, Reisfield GM, Dasgupta N. Eight principles for safer opioid prescribing and cautions with benzodiazepines. Postgrad Med 2014; 127:27-32. [PMID: 25526233 DOI: 10.1080/00325481.2015.993276] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The provision of long-term opioid analgesic therapy for chronic pain requires a careful risk/benefit analysis followed by clinical safety measures to identify and reduce misuse, abuse, and addiction and their associated morbidity and mortality. Multiple data sources show that benzodiazepines, prescribed for comorbid insomnia, anxiety, and mood disorders, heighten the risk of respiratory depression and other adverse outcomes when combined with opioid therapy. Evidence is presented for hazards associated with coadministration of opioids and benzodiazepines and the need for caution when initiating opioid therapy for chronic pain. Clinical recommendations follow, as drawn from 2 previously published literature reviews, one of which proffers 8 principles for safer opioid prescribing; the other review presents risks associated with benzodiazepines, suggests alternatives for co-prescribing benzodiazepines and opioids, and outlines recommendations regarding co-prescribing if alternative therapies are ineffective.
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Fraser LA, Adachi JD, Leslie WD, Goltzman D, Josse R, Prior J, Kaiser S, Kreiger N, Kovacs CS, Anastassiades TP, Papaioannou A. Effect of Anticholinergic Medications on Falls, Fracture Risk, and Bone Mineral Density Over a 10-Year Period. Ann Pharmacother 2014; 48:954-961. [PMID: 24816210 DOI: 10.1177/1060028014535363] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Many medications used in older adults have strong anticholinergic (ACH) properties, which may increase the risk of falls and fractures. Use of these medications was identified in a population-based Canadian cohort. OBJECTIVE To identify the fall and fracture risk associated with ACH medication use. METHODS Data collection and analysis were conducted at baseline, year 5, and year 10. Cross-sectional analyses were performed to examine associations between ACH medication use and falls. Time-dependent Cox regression was used to examine time to first nontraumatic fracture. Finally, change in bone mineral density (BMD) over 10 years was compared in ACH medication users versus nonusers. RESULTS Strongly ACH medications were used by 618 of 7753 participants (8.0%) at study baseline, 592 (9.5%) at year 5, and 334 (7.7%) at year 10. Unadjusted ACH medication use was associated with falls at baseline (odds ratio = 1.50; 95% CI = 1.14-1.98; P = 0.004), but the association was no longer significant after covariate adjustment. Similar results occurred at years 5 and 10. ACH medication use was associated with increased incident fracture risk before (hazard ratio = 1.22; CI = 1.13-1.32; P < 0.001) but not after covariate adjustment. Mean (SD) change in femoral neck BMD T-score over 10 years, in those using ACH medications at both years 0 and 5, was -0.60 (0.63) in ACH users versus -0.49 (0.45) in nonusers (P = 0.041), but this was not significant after covariate adjustment. CONCLUSIONS ACH medications were not found to be independently associated with an increased risk of falling, fractures, or BMD loss. Rather, factors associated with ACH medication use explained the apparent associations.
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Xing D, Ma XL, Ma JX, Wang J, Yang Y, Chen Y. Association between use of benzodiazepines and risk of fractures: a meta-analysis. Osteoporos Int 2014; 25:105-20. [PMID: 24013517 DOI: 10.1007/s00198-013-2446-y] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 06/14/2013] [Indexed: 01/11/2023]
Abstract
UNLABELLED Benzodiazepines (BZDs) are some of the most commonly prescribed drugs in the world. It has been shown that BZD use could be associated with increased fracture risk. However, studies on the use of BZDs and fracture risk have yielded inconsistent results. Results from the present meta-analysis show that BZD use is associated with a moderate and clinically significant increase in the risk of fractures. INTRODUCTION The relationship between the use of BZDs and fracture risk has been neither well identified nor summarized. This meta-analysis reports on the use of BZDs, especially short-acting BZDs, and their correlation with a moderate and clinically significant increase in fracture risk. This analysis will provide evidence for clinicians to consider fracture risk when prescribing BZDs among the elderly population. This study was conducted to determine whether people who take BZDs are at an increased fracture risk. METHODS A systematic search of studies published through January 2013 was conducted using MEDLINE, EMBASE, OVID, and ScienceDirect. Case-control and cohort studies that assessed the relationship between BZD use and the risk of fractures were identified. Literature searches, study selections, methodological assessments, and data mining were independently conducted by two reviewers. Disagreements were resolved by consensus. STATA 12.0 software was used for the meta-analysis. Random effects models were used for pooled analysis due to heterogeneity among the studies. RESULTS There were 25 studies, including 19 case-control studies and 6 cohort studies, that met the inclusion criteria. Overall, the results of the meta-analysis indicated that BZD use was associated with a significantly increased fracture risk (relative risk (RR) = 1.25; 95% confidence intervals (CI), 1.17-1.34; p < 0.001). Increased fracture risk associated with BZD use was observed in participants aged ≥65 years old (RR = 1.26; 95% CI, 1.15-1.38; p < 0.001). When only hip fractures were included as the outcome measure, the RR increased to 1.35. However, subgroup meta-analyses showed that there was no significant association between BZD use and fracture risk in Eastern countries (RR = 1.27; 95% CI, 0.76-2.14; p = 0.362) as well as between long-acting BZD use and risk of fractures (RR = 1.21; 95% CI, 0.95-1.54; p = 0.12). After accounting for publication bias, we observed that the overall association between BZD use and fracture risk to be slightly weaker (RR = 1.21; 95% CI, 1.13-1.30) but still significant. CONCLUSION The results of this meta-analysis demonstrate that the use of BZD, especially short-acting BZD, is associated with a moderate and clinically significant increase in fracture risk. However, large prospective studies that minimize selection bias are necessary to determine a more accurate fracture risk associated with BZD use.
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Affiliation(s)
- D Xing
- Department of Orthopaedics Institute, Tianjin Hospital, 406 Jiefang Nan Street, Hexi District, Tianjin, 300211, China
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Reisfield GM, Webster LR. Benzodiazepines in Long-Term Opioid Therapy. PAIN MEDICINE 2013; 14:1441-6. [DOI: 10.1111/pme.12236] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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