Health Services Research Unit (HØKH), Akershus University Hospital, PO Box 1000, 1478, Lørenskog, Norway.
Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, Lørenskog, Norway.
BMC Geriatr. 2020 Oct 23;20(1):425. doi: 10.1186/s12877-020-01838-8.
Central nervous system depressant medications (CNSDs) such as opioid analgesics and sedative-hypnotics are commonly prescribed to older patients for the treatment of chronic pain, anxiety and insomnia. Yet, while many studies reported potential harms, it remains unknown whether persistent use of these medications is beneficial for older patients' self-reported health-related quality of life (HRQoL). The present study clarified this knowledge gap through comparing HRQoL of hospitalized older patients with versus without using CNSD drugs for ≥4 weeks. Moreover, we explored the relationship between such use and HRQoL, adjusting for the effects of polypharmacy, comorbidity burden and other clinically relevant covariates.
The study was cross-sectional and included 246 older patients recruited consecutively from somatic departments of a large regional university hospital in Norway. We defined prolonged CNSD use as using opioids, benzodiazepines and/or z-hypnotics for ≥4 weeks. Patients' self-reported HRQoL were measured with scales of the EuroQol EQ-5D-3L instrument. Data analyses were mainly descriptive statistics and regression models.
Patients with prolonged use of CNSDs reported lower scores on both EQ-5D index and EQ VAS compared with those without such use (p < 0.001). They had higher odds of having more problems performing usual activities (OR = 3.37, 95% CI: 1.40 to 8.13), pain/discomfort (OR = 2.06, 95% CI: 1.05 to 4.04), and anxiety/depression (OR = 3.77, 95% CI: 1.82 to 7.82). In multivariable regression models, there was no significant association between prolonged CNSD use and HRQoL when including pain as a predictor variable. In models not including pain, CNSD use was strongly associated with HRQoL (adjusted for sociodemographic background, polypharmacy, comorbidity, anxiety and depressive symptoms, regression coefficient - 0.19 (95% CI, - 0.31 to - 0.06).
Older patients with prolonged CNSD use reported poorer HRQoL. They also had more pain and higher depression scores. Prolonged use of CNSDs was not independently associated with higher HRQoL.
中枢神经系统抑制剂（CNSD），如阿片类镇痛药和镇静催眠药，常被用于治疗慢性疼痛、焦虑和失眠等病症。然而，尽管许多研究报告了这些药物的潜在危害，但仍不清楚持续使用这些药物是否有益于老年患者的自我报告健康相关生活质量（HRQoL）。本研究通过比较使用和不使用中枢神经系统药物≥4 周的住院老年患者的 HRQoL，来阐明这一知识空白。此外，我们还探讨了这种使用与 HRQoL 之间的关系，调整了多药治疗、合并症负担和其他临床相关协变量的影响。
该研究为横断面研究，共纳入 246 名连续从挪威一家大型地区大学医院的躯体科招募的老年患者。我们将长期使用中枢神经系统抑制剂定义为使用阿片类药物、苯二氮䓬类药物和/或 Z 催眠药≥4 周。患者的自我报告 HRQoL 采用欧洲五维健康量表（EQ-5D-3L）的量表进行测量。数据分析主要采用描述性统计和回归模型。
与未使用 CNSD 的患者相比，长期使用 CNSD 的患者在 EQ-5D 指数和 EQ VAS 上的得分均较低（p<0.001）。他们在进行日常活动时出现更多问题的可能性更高（OR=3.37，95%CI：1.40-8.13）、疼痛/不适（OR=2.06，95%CI：1.05-4.04）和焦虑/抑郁（OR=3.77，95%CI：1.82-7.82）。在多变量回归模型中，当包括疼痛作为预测变量时，长期使用中枢神经系统抑制剂与 HRQoL 之间没有显著关联。在不包括疼痛的模型中，CNSD 使用与 HRQoL 密切相关（调整社会人口学背景、多药治疗、合并症、焦虑和抑郁症状后，回归系数为-0.19（95%CI：-0.31 至-0.06）。
长期使用中枢神经系统抑制剂的老年患者报告的 HRQoL 较差。他们也有更多的疼痛和更高的抑郁评分。长期使用中枢神经系统抑制剂与较高的 HRQoL 无关。
