Prescribed Opioid Use is Associated with Increased All-purpose Emergency Department Visits and Hospitalizations in Community-dwelling Older Adults in the United States

Overview

Journal Front Psychiatry

Specialty Psychiatry

Date 2022 Dec 30

PMID 36582257

Authors

Song Ge

Chong Tian

Liang Wu

Minhui Liu

Haidong Lu

Affiliations

Soon will be listed here.

Abstract

Background: The geriatric and health characteristics of older adults make them more susceptible to the effects of opioids than younger groups. The number of older adults in the United States visiting the emergency department (ED) and overusing opioids has increased in recent years. Research examining their relationship is, however, limited.

Methods: Using information from the 2020 National Health Interview Survey (NHIS), we included older adults aged 65 and older. To investigate the relationship between prescribed opioid use and 12-months ED visits and hospitalizations, linear regression and logistic regression models were built while adjusting for age, sex, ethnicity, education, employment, general health status, history of depression, and living arrangement.

Results: Our study population consisted of 8,631 participants (mean age 74.3). Most of them were females (58.3%) and Caucasian (81.6%). About 16% of the participants used prescribed opioids over the past 12 months. Of the participants with prescribed opioid use, 65.1% of them did so to treat chronic pain. The adjusted regression models revealed that prescribed opioid use was independently and positively associated with 12-months ED visits (β = 0.22, 95% confidence interval [CI] 0.18, 0.26) and hospitalizations (Odds ratio [OR] = 3.78, 95% CI 3.29, 4.35). Other risk factors for 12-months ED visits and/or hospitalizations included advanced age, male gender, unemployment/retirement, African American ethnicity, living alone, fair or poor general health status, and history of depression.

Discussions: Clinicians should screen older adults at high risk for ED visits and hospitalizations and explore multimodal pain management with them to help them reduce/stop using opioids. These efforts may decrease their chronic pain, opioid use, opioid use-related adverse health outcomes, ED visits, as well as hospitalizations.

References

Papaleontiou M, Henderson Jr C, Turner B, Moore A, Olkhovskaya Y, Amanfo L . Outcomes associated with opioid use in the treatment of chronic noncancer pain in older adults: a systematic review and meta-analysis. J Am Geriatr Soc. 2010; 58(7):1353-69. PMC: 3114446. DOI: 10.1111/j.1532-5415.2010.02920.x. View

Stompor M, Grodzicki T, Stompor T, Wordliczek J, Dubiel M, Kurowska I . Prevalence of Chronic Pain, Particularly with Neuropathic Component, and Its Effect on Overall Functioning of Elderly Patients. Med Sci Monit. 2019; 25:2695-2701. PMC: 6475124. DOI: 10.12659/MSM.911260. View

Han B, Compton W, Blanco C, Crane E, Lee J, Jones C . Prescription Opioid Use, Misuse, and Use Disorders in U.S. Adults: 2015 National Survey on Drug Use and Health. Ann Intern Med. 2017; 167(5):293-301. DOI: 10.7326/M17-0865. View

Chang Y . Factors associated with prescription opioid misuse in adults aged 50 or older. Nurs Outlook. 2018; 66(2):112-120. PMC: 5916579. DOI: 10.1016/j.outlook.2017.10.007. View

Vadivelu N, Kai A, Kodumudi V, Sramcik J, Kaye A . The Opioid Crisis: a Comprehensive Overview. Curr Pain Headache Rep. 2018; 22(3):16. DOI: 10.1007/s11916-018-0670-z. View

Wongrakpanich S, Wongrakpanich A, Melhado K, Rangaswami J . A Comprehensive Review of Non-Steroidal Anti-Inflammatory Drug Use in The Elderly. Aging Dis. 2018; 9(1):143-150. PMC: 5772852. DOI: 10.14336/AD.2017.0306. View

Pergolizzi J, Boger R, Budd K, Dahan A, Erdine S, Hans G . Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl,.... Pain Pract. 2008; 8(4):287-313. DOI: 10.1111/j.1533-2500.2008.00204.x. View

Saarto T, Wiffen P . Antidepressants for neuropathic pain: a Cochrane review. J Neurol Neurosurg Psychiatry. 2010; 81(12):1372-3. DOI: 10.1136/jnnp.2008.144964. View

Parsons V, Moriarity C, Jonas K, Moore T, Davis K, Tompkins L . Design and estimation for the national health interview survey, 2006-2015. Vital Health Stat 2. 2014; (165):1-53. View

10.

Welsh J, Mataczynski M, Nguyen M, McHugh R . A Review of Behavioral Therapies in Adolescents with Opioid Use Disorder. Harv Rev Psychiatry. 2020; 28(5):305-315. DOI: 10.1097/HRP.0000000000000272. View

11.

Tsao J . Effectiveness of massage therapy for chronic, non-malignant pain: a review. Evid Based Complement Alternat Med. 2007; 4(2):165-79. PMC: 1876616. DOI: 10.1093/ecam/nel109. View

12.

Rosoff D, Davey Smith G, Lohoff F . Prescription Opioid Use and Risk for Major Depressive Disorder and Anxiety and Stress-Related Disorders: A Multivariable Mendelian Randomization Analysis. JAMA Psychiatry. 2020; 78(2):151-160. PMC: 7658804. DOI: 10.1001/jamapsychiatry.2020.3554. View

13.

Mior S . Exercise in the treatment of chronic pain. Clin J Pain. 2002; 17(4 Suppl):S77-85. DOI: 10.1097/00002508-200112001-00016. View

14.

Compton W, Boyle M, Wargo E . Prescription opioid abuse: Problems and responses. Prev Med. 2015; 80:5-9. DOI: 10.1016/j.ypmed.2015.04.003. View

15.

Koeppe J, Lyda K, Armon C . Association between opioid use and health care utilization as measured by emergency room visits and hospitalizations among persons living with HIV. Clin J Pain. 2013; 29(11):957-61. DOI: 10.1097/AJP.0b013e31827c7b05. View

16.

Schepis T, McCabe S, Teter C . Sources of opioid medication for misuse in older adults: results from a nationally representative survey. Pain. 2018; 159(8):1543-1549. PMC: 6053324. DOI: 10.1097/j.pain.0000000000001241. View

17.

Schwan J, Sclafani J, Tawfik V . Chronic Pain Management in the Elderly. Anesthesiol Clin. 2019; 37(3):547-560. PMC: 6658091. DOI: 10.1016/j.anclin.2019.04.012. View

18.

Lynch T . Management of drug-drug interactions: considerations for special populations--focus on opioid use in the elderly and long term care. Am J Manag Care. 2011; 17 Suppl 11:S293-8. View

19.

Weissman J, Russell D, Taylor J . Disparities in Opioid Prescribing for Long-Term Chronic and Short-Term Acute Pain: Findings from the 2019 National Health Interview Survey. J Behav Health Serv Res. 2022; 49(3):315-334. DOI: 10.1007/s11414-022-09790-8. View

20.

Brennan Braden J, Russo J, Fan M, Edlund M, Martin B, DeVries A . Emergency department visits among recipients of chronic opioid therapy. Arch Intern Med. 2010; 170(16):1425-32. PMC: 3715046. DOI: 10.1001/archinternmed.2010.273. View