Clinical and Functional Characteristics of Nursing Facility Residents with Opioid-Induced Constipation.

OBJECTIVE

Our goal was to determine the prevalence, clinical characteristics, and treatment differences of opioid-induced constipation (OIC) in older adults with noncancer pain compared with opioid-treated patients without OIC.

DESIGN

Retrospective database analysis.

SETTING

United States nursing facilities: Patients, Participants, facility residents.

INTERVENTIONS

None.

MAIN OUTCOME MEASURE(S): Minimum data set and prescription claims, pain, impaired cognition, falls, delirium, and drug treatment.

RESULTS

We found an OIC prevalence of 8.9%. Nursing facility residents with OIC are more likely to have severe pain (31.3% vs. 29%; P < 0.001), pain in the last 5 days (71.2% vs. 69.2%; P < 0.001), almost constant pain (18.1% vs.13.3%; P < 0.001), and pain interfering with daily activities (36.1% vs. 30%; P < 0.001). Strong opioids were more likely prescribed and the duration of use was longer than in non-OIC nursing facility residents. Cognitive impairment (56.3% vs. 49.8%; P < 0.001), fall rate (4.8% vs. 2.5%; P = 0.023), delirium indicators (confusion assessment method; P < 0.001), urinary incontinence (59.1% vs. 54.9%; P < 0.001), depression (66.5% vs. 61.6%; P < 0.001), and depression severity score (4.7% vs. 4.3%; P < 0.001) were higher in nursing facility residents with OIC. Nursing facility residents with OIC had a higher percentage of concomitantly prescribed anticholinergic medications (76.7% vs. 70.0%; P < 0.001) and a higher mean anticholinergic burden score (1.4% vs. 1.1%; P < 0.001). Over-the-counter laxatives were used more often than prescription laxatives: polyethylene glycol (43%), docusate (31.1%), and senna/sennosides (23%) vs. lactulose (18.1%) and lubiprostone (2.2%).

CONCLUSION

Nursing facility residents with OIC experience suboptimal pain relief, additional anticholinergic adverse drug-related effects, and a decreased quality of life.