Department of Epidemiology, University of Kentucky, Lexington, Kentucky, United States of America.
Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, United States of America.
PLoS One. 2019 Jan 11;14(1):e0210341. doi: 10.1371/journal.pone.0210341. eCollection 2019.
Given the controversy around the effectiveness of opioid treatment for chronic pain and the lack of detailed guidance for prescribing opioids in older adults, the objectives of this study were to estimate the trajectories and predictors of opioid use in older adults.
Data were extracted from the National Alzheimer's Coordinating Center (2005-2017). Group-based trajectory modeling was used to identify the patterns of opioid use (any or strong) among participants age 65+. We used multivariable logistic regression with backward selection to evaluate demographics and comorbidities as potential predictors of trajectory membership.
Among 13,059 participants, four trajectories were identified for the use of both any opioids and strong opioids (minimal-users, incident chronic-users, discontinuing-users, and prevalent chronic-users). For any opioids, female sex (adjusted odds ratio = 1.23; 95% confidence interval = 1.03-1.46), black vs. white (1.47; 1.18-1.82), year of education (0.96; 0.94-0.99), type of residence (independent group vs. private: 1.77; 1.38-2.26, care facility vs. private: 1.89; 1.20-2.97), hypertension (1.44; 1.20-1.72), cardiovascular disease (1.30; 1.09-1.55), urinary incontinence (1.45; 1.19-1.78), dementia (0.73; 0.57-0.92), number of medications (1 to 4 vs. none: 0.48; 0.36-0.64, 5 or more vs. none: 0.67; 0.50-0.88), and antidepressant agent (1.38; 1.14-1.67) were associated with incident chronic-use vs. non-use. For strong opioids, female sex (1.27; 1.04-1.56), type of residence (independent group vs. private: 1.90; 1.43-2.53, care facility vs. private: 2.37; 1.44-3.90), current smoking (1.68; 1.09-2.60), hypertension (1.49; 1.21-1.83), urinary incontinence (1.45; 1.14-1.84), dementia (0.73; 0.55-0.97), number of medications (1 to 4 vs. none: 0.46; 0.32-0.65, 5 or more vs. none: 0.59; 0.42-0.83), and antidepressant agent (1.55; 1.24-1.93) were associated with incident chronic-use vs. non-use.
Given that chronic opioid use was more prevalent in participants who were more vulnerable (i.e., older age, with multiple comorbidities, and polypharmacy), further studies should evaluate the safety and efficacy of using opioids in this population.
鉴于阿片类药物治疗慢性疼痛的有效性存在争议，且缺乏针对老年人开阿片类药物的详细指导，本研究旨在评估老年人阿片类药物使用的轨迹和预测因素。
数据来自国家阿尔茨海默病协调中心（2005-2017 年）。采用基于群组的轨迹建模来识别 65 岁及以上参与者中使用任何阿片类药物和强阿片类药物（轻度使用者、新发慢性使用者、停药使用者和普遍慢性使用者）的模式。我们使用多变量逻辑回归和向后选择来评估人口统计学和合并症是否可能是轨迹成员的预测因素。
在 13059 名参与者中，确定了使用任何阿片类药物和强阿片类药物（轻度使用者、新发慢性使用者、停药使用者和普遍慢性使用者）的四个轨迹。对于任何阿片类药物，女性（调整后的优势比=1.23；95%置信区间=1.03-1.46）、黑人与白人（1.47；1.18-1.82）、受教育年限（0.96；0.94-0.99）、居住类型（独立群体与私人：1.77；1.38-2.26，护理机构与私人：1.89；1.20-2.97）、高血压（1.44；1.20-1.72）、心血管疾病（1.30；1.09-1.55）、尿失禁（1.45；1.19-1.78）、痴呆（0.73；0.57-0.92）、用药数量（1-4 种与无：0.48；0.36-0.64，5 种或更多与无：0.67；0.50-0.88）和抗抑郁药（1.38；1.14-1.67）与新发慢性使用与非使用相关。对于强阿片类药物，女性（1.27；1.04-1.56）、居住类型（独立群体与私人：1.90；1.43-2.53，护理机构与私人：2.37；1.44-3.90）、当前吸烟（1.68；1.09-2.60）、高血压（1.49；1.21-1.83）、尿失禁（1.45；1.14-1.84）、痴呆（0.73；0.55-0.97）、用药数量（1-4 种与无：0.46；0.32-0.65，5 种或更多与无：0.59；0.42-0.83）和抗抑郁药（1.55；1.24-1.93）与新发慢性使用与非使用相关。
鉴于慢性阿片类药物使用在更脆弱的参与者（即年龄较大、合并多种疾病和多药治疗）中更为普遍，因此应进一步研究在该人群中使用阿片类药物的安全性和疗效。
