长期居住在养老院的居民中长期使用阿片类药物的情况。
Prevalence of Long-Term Opioid Use in Long-Stay Nursing Home Residents.
机构信息
Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
Department of Family Medicine, Alpert Medical School, Brown University, Memorial Hospital of Rhode Island, Providence, Rhode Island.
出版信息
J Am Geriatr Soc. 2018 Jan;66(1):48-55. doi: 10.1111/jgs.15080. Epub 2017 Sep 21.
BACKGROUND/OBJECTIVES: Overall and long-term opioid use among older adults have increased since 1999. Less is known about opioid use in older adults in nursing homes (NHs).
DESIGN
Cross-sectional.
SETTING
U.S. NHs (N = 13,522).
PARTICIPANTS
Long-stay NH resident Medicare beneficiaries with a Minimum Data Set 3.0 (MDS) assessment between April 1, 2012, and June 30, 2012, and 120 days of follow-up (N = 315,949).
MEASUREMENTS
We used Medicare Part D claims to measure length of opioid use in the 120 days from the index assessment (short-term: ≤30 days, medium-term: >30-89 days, long-term: ≥90 days), adjuvants (e.g., anticonvulsants), and other pain medications (e.g., corticosteroids). MDS assessments in the follow-up period were used to measure nonpharmacological pain management use. Modified Poisson models were used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for age, gender, race and ethnicity, cognitive and physical impairment, and long-term opioid use.
RESULTS
Of all long-stay residents, 32.4% were prescribed any opioid, and 15.5% were prescribed opioids long-term. Opioid users (versus nonusers) were more commonly prescribed pain adjuvants (32.9% vs 14.9%), other pain medications (25.5% vs 11.0%), and nonpharmacological pain management (24.5% vs 9.3%). Long-term opioid use was higher in women (aPR = 1.21, 95% CI = 1.18-1.23) and lower in racial and ethnic minorities (non-Hispanic blacks vs whites: APR = 0.93, 95% CI = 0.90-0.94) and those with severe cognitive impairment (vs no or mild impairment, aPR = 0.82, 95% CI = 0.79-0.83).
CONCLUSION
One in seven NH residents was prescribed opioids long-term. Recent guidelines on opioid prescribing for pain recommend reducing long-term opioid use, but this is challenging in NHs because residents may not benefit from nonpharmacological and nonopioid interventions. Studies to address concerns about opioid safety and effectiveness (e.g., on pain and functional status) in NHs are needed.
背景/目的：自 1999 年以来，老年人的整体和长期阿片类药物使用有所增加。关于养老院（NH）中老年人的阿片类药物使用情况，人们了解较少。
设计
横断面研究。
地点
美国 NH（N=13522）。
参与者
在 2012 年 4 月 1 日至 2012 年 6 月 30 日期间接受最低数据集 3.0（MDS）评估并进行 120 天随访的长期 NH 居民 Medicare 受益人（N=315949）。
测量
我们使用 Medicare 第 D 部分索赔来衡量从指数评估之日起 120 天内的阿片类药物使用情况（短期：≤30 天，中期：>30-89 天，长期：≥90 天）、辅助剂（例如，抗惊厥药）和其他止痛药（例如，皮质类固醇）。在随访期间的 MDS 评估用于衡量非药物性疼痛管理的使用情况。使用修正泊松模型估计年龄、性别、种族和民族、认知和身体功能障碍以及长期阿片类药物使用的调整后患病率比（aPR）和 95%置信区间（CI）。
结果
在所有长期居民中，32.4%的人被开处任何阿片类药物处方，15.5%的人被开处长期阿片类药物处方。阿片类药物使用者（与非使用者相比）更常被开处疼痛辅助剂（32.9%比 14.9%）、其他止痛药（25.5%比 11.0%）和非药物性疼痛管理（24.5%比 9.3%）。女性的长期阿片类药物使用比例较高（aPR=1.21，95%CI=1.18-1.23），非裔和西班牙裔少数民族（非西班牙裔黑人与白人相比：aPR=0.93，95%CI=0.90-0.94）以及认知功能严重受损者（与无或轻度受损者相比：aPR=0.82，95%CI=0.79-0.83）较低。
结论
七分之一的 NH 居民被开处长期阿片类药物处方。最近关于疼痛阿片类药物处方的指南建议减少长期阿片类药物使用，但在 NH 中这具有挑战性，因为居民可能无法从非药物和非阿片类干预措施中受益。需要研究来解决 NH 中关于阿片类药物安全性和有效性的担忧（例如，对疼痛和功能状态的影响）。
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