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Drugs & Aging

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17.06.2022 | Original Research Article

Incident Functional Limitations Among Community-Dwelling Adults Using Opioids: A Retrospective Cohort Study Using a Propensity Analysis with the Health and Retirement Study

verfasst von: Kevin T. Pritchard, Brian Downer, Mukaila A. Raji, Jacques Baillargeon, Yong-Fang Kuo

Erschienen in: Drugs & Aging | Ausgabe 7/2022

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Abstract

Background

Opioid analgesics are commonly used to manage pain; however, it is unclear how they affect patient function. This study examines the association between opioid analgesics and incident limitations in activities of daily living (ADL), instrumental activities of daily living (IADL), and cognitive functioning among community-dwelling older adults.

Methods

Data included 10,003 participants of the 2016 and 2018 waves of the Health and Retirement Study, which sampled US adults aged 51–98 years. The primary exposure was self-reported opioid pain medication use in 2016. Outcomes included incident limitations in ADL, IADL, and cognitive functioning in 2018. Statistical methods adjusted for confounding using multivariable logistic regressions, inverse probability of treatment weighting, and propensity scores.

Results

Opioid use (adjusted odds ratio [aOR]: 1.34, 95% confidence interval [CI] 1.07–1.68) was associated with a statistically significant higher odds of incident ADL limitation in multivariable regression and in propensity score adjustment (aOR: 1.41, 95% CI 1.13–1.76). The association between opioid use and ADL and IADL limitations was modified by age. Adults aged < 65 years had a higher odds of incident ADL (aOR: 1.83, 95% CI 1.38–2.42) and IADL (aOR: 1.42, 95% CI 1.06–1.90) limitations compared with those aged ≥ 65 years.

Conclusions

Community-dwelling adults using opioid analgesics to manage pain may be at risk for incident ADL limitations. Middle-aged adults, compared with those older than 65 years of age, experienced the greatest odds for incident ADL and IADL limitations following opioid use. According to sensitivity analyses, our findings were robust to unmeasured confounding.

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Dahlhamer J, et al. Prevalence of chronic pain and high-impact chronic pain among adults: United States, 2016. MMWR Morb Mortality Wkly Rep. 2018;67(36):1001–6. https://doi.org/10.15585/mmwr.mm6736a2.CrossRef

Patel KV, et al. Prevalence and impact of pain among older adults in the United States: findings from the 2011 National Health and Aging Trends Study. Pain. 2013;154(12):2649–57. https://doi.org/10.1016/j.pain.2013.07.029.CrossRefPubMed

Institute of Medicine. Relieving pain in America: a blueprint for transforming prevention, care, education, and research. Washington, DC: The National Academies Press; 2011. https://doi.org/10.3109/15360288.2012.678473.CrossRef

Dahlhamer JM, Connor EM, Bose J, Lucas JW, Zelaya CE. Prescription opioid use among adults with chronic pain: United States, 2019. National Health Statistics Reports; no 162. Hyattsville, MD: National Center for Health Statistics. 2021. https://doi.org/10.15620/cdc:107641

Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain: United States, 2016. JAMA. 2016;315(15):1624–45. https://doi.org/10.1001/jama.2016.1464.CrossRefPubMedPubMedCentral

O’Neil CK, Hanlon JR, Marcum ZA. Adverse effects of analgesics commonly used by older adults with osteoarthritis: focus on non-opioid and opioid analgesics. Am J Geriatr Pharmacother. 2012;10(6):331–42. https://doi.org/10.1016/j.amjopharm.2012.09.004.CrossRefPubMedPubMedCentral

Volkow ND, McLellan AT. Opioid abuse in chronic pain: misconceptions and mitigation strategies. N Engl J Med. 2016;374(13):1253–63. https://doi.org/10.1056/NEJMra1507771.CrossRefPubMed

Shah R, et al. Association of co-prescribing of opioid and benzodiazepine substitutes with incident falls and fractures among older adults: a cohort study. BMJ Open. 2021;11(12): e052057. https://doi.org/10.1136/bmjopen-2021-052057.CrossRefPubMedPubMedCentral

Drug Enforcement Administration, Department of Justice. Schedules of controlled substances: rescheduling of hydrocodone combination products from schedule III to schedule II. Final rule. Fed Regist. 2014;79(163):49661.

10.

Kuo YF, et al. Opioid prescriptions in older medicare beneficiaries after the 2014 federal rescheduling of hydrocodone products. J Am Geriatr Soc. 2018;66(5):945–53. https://doi.org/10.1111/jgs.15332.CrossRefPubMedPubMedCentral

11.

Liaw V, et al. Opioid prescribing among adults with disabilities in the United States after the 2014 Federal Hydrocodone Rescheduling Regulation. Public Health Rep. 2020;135(1):114–23. https://doi.org/10.1177/0033354919892638.CrossRefPubMed

12.

Scholl L, et al. Drug and opioid-involved overdose deaths: United States, 2013–2017. MMWR Morb Mortal Wkly Rep. 2019;67(5152):1419. https://doi.org/10.15585/mmwr.mm675152e1.CrossRef

13.

Chou R, et al. Opioid treatments for chronic pain comparative effectiveness review, vol. 229. Rockville: Agency for Healthcare Research and Quality (US); 2020. https://doi.org/10.23970/AHRQEPCCER229.CrossRef

14.

Sites BD, Beach ML, Davis MA. Increases in the use of prescription opioid analgesics and the lack of improvement in disability metrics among users. Reg Anesth Pain Med. 2014;39(1):6–12. https://doi.org/10.1097/AAP.0000000000000022.CrossRefPubMedPubMedCentral

15.

Schnitzer TJ, et al. Efficacy of tramadol in treatment of chronic low back pain. J Rheumatol. 2000;27(3):772–8.PubMed

16.

Steiner DJ, et al. Efficacy and safety of the seven-day buprenorphine transdermal system in opioid-naive patients with moderate to severe chronic low back pain: an enriched, randomized, double-blind, placebo-controlled study. J Pain Symptom Manag. 2011;42(6):903–17. https://doi.org/10.1016/j.jpainsymman.2011.04.006.CrossRef

17.

Veiga DR, et al. Effectiveness of opioids for chronic noncancer pain: a two-year multicenter, prospective cohort study with propensity score matching. J Pain. 2019;20(6):706–15. https://doi.org/10.1016/j.jpain.2018.12.007.CrossRefPubMed

18.

Sonnega A, et al. Cohort profile: the Health and Retirement Study (HRS). Int J Epidemiol. 2014;43(2):576–85. https://doi.org/10.1093/ije/dyu067.CrossRefPubMedPubMedCentral

19.

Fonda S, Herzog AR. Documentation of physical functioning measured in the Health and Retirement Study and the asset and health dynamics among the Oldest Old Study. Ann Arbor: University of Michigan Survey Research Center; 2004.

20.

Crimmins EM, et al. Assessment of cognition using surveys and neuropsychological assessment: the Health and Retirement Study and the Aging, Demographics, and Memory Study. J Gerontol B Psychol Sci Soc Sci. 2011;66(Suppl. 1):i162–71.CrossRef

21.

Katz S, et al. Studies of illness in the aged: the index of ADL: a standardized measure of biological and psychosocial function. JAMA. 1963;185(12):914–9. https://doi.org/10.1001/jama.1963.03060120024016.CrossRefPubMed

22.

Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3_Part_1):179–86.CrossRef

23.

Langa KM, et al. A comparison of the prevalence of dementia in the United States in 2000 and 2012. JAMA Intern Med. 2017;177(1):51–8. https://doi.org/10.1001/jamainternmed.2016.6807.CrossRefPubMedPubMedCentral

24.

Tisnado DM, et al. What is the concordance between the medical record and patient self-report as data sources for ambulatory care? Med Care. 2006;44(2):132–40.CrossRef

25.

Steffick DE, Wallace RB, Herzog AR (2000) Documentation of affective functioning measures in the Health and Retirement Study. Ann Arbor, MI: University of Michigan.

26.

Austin PC. Using the standardized difference to compare the prevalence of a binary variable between two groups in observational research. Commun Stat-Simul C. 2009;38(6):1228–34. https://doi.org/10.1080/03610910902859574.CrossRef

27.

Team R. RStudio: integrated development environment for R. Boston: RStudio, PBC; 2020.

28.

DuGoff EH, Schuler M, Stuart EA. Generalizing observational study results: applying propensity score methods to complex surveys. Health Serv Res. 2014;49(1):284–303.CrossRef

29.

Lin DY, Psaty BM, Kronmal RA. Assessing the sensitivity of regression results to unmeasured confounders in observational studies. Biometrics. 1998;54(3):948–63.CrossRef

30.

Pollack SW, Skillman SM, Frogner BK. The health workforce delivering evidence-based non-pharmacological pain management. Seattle: University of Washington, Center for Health Workforce Studies; 2020.

31.

Karmali RN, et al. The association between the supply of select nonpharmacologic providers for pain and use of nonpharmacologic pain management services and initial opioid prescribing patterns for Medicare beneficiaries with persistent musculoskeletal pain. Health Serv Res. 2021;56(2):275–88. https://doi.org/10.1111/1475-6773.13561.CrossRefPubMed

32.

Clark F, et al. Effectiveness of a lifestyle intervention in promoting the well-being of independently living older people: results of the well elderly 2 randomised controlled trial. J Epidemiol Community Health. 2012;66(9):782–90. https://doi.org/10.1136/jech.2009.099754.CrossRefPubMed

33.

Deandrea S, et al. Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiology. 2010;21(5):658–68.CrossRef

34.

DeRigne L, Stoddard-Dare P, Quinn L. Workers without paid sick leave less likely to take time off for illness or injury compared to those with paid sick leave. Health Aff (Millwood). 2016;35(3):520–7. https://doi.org/10.1377/hlthaff.2015.0965.CrossRefPubMed

35.

Gaskin DJ, Richard P. The economic costs of pain in the United States. J Pain. 2012;13(8):715–24. https://doi.org/10.1016/j.jpain.2012.03.009.CrossRefPubMed

36.

Riffin C, et al. Multifactorial examination of caregiver burden in a national sample of family and unpaid caregivers. J Am Geriatr Soc. 2019;67(2):277–83. https://doi.org/10.1111/jgs.15664.CrossRefPubMed

37.

Clegg A, Young JB. Which medications to avoid in people at risk of delirium: a systematic review. Age Ageing. 2011;40(1):23–9. https://doi.org/10.1093/ageing/afq140.CrossRefPubMed

38.

Cherrier MM, et al. Comparative cognitive and subjective side effects of immediate-release oxycodone in healthy middle-aged and older adults. J Pain. 2009;10(10):1038–50. https://doi.org/10.1016/j.jpain.2009.03.017.CrossRefPubMedPubMedCentral

39.

Whitlock EL, et al. Association between persistent pain and memory decline and dementia in a longitudinal cohort of elders. JAMA Intern Med. 2017;177(8):1146–53. https://doi.org/10.1001/jamainternmed.2017.1622.CrossRefPubMedPubMedCentral

40.

Allegri N, et al. Systematic review and meta-analysis on neuropsychological effects of long-term use of opioids in patients with chronic noncancer pain. Pain Pract. 2019;19(3):328–43. https://doi.org/10.1111/papr.12741.CrossRefPubMed

41.

Kendall SE, et al. The cognitive effects of opioids in chronic non-cancer pain. Pain. 2010;150(2):225–30. https://doi.org/10.1016/j.pain.2010.05.012.CrossRefPubMed

42.

Giles GM, et al. Making functional cognition a professional priority. Am J Occup Ther. 2020;74(1):7401090010p1–6. https://doi.org/10.5014/ajot.2020.741002.CrossRefPubMedPubMedCentral

43.

Esechie A, et al. Trends in prescribing pattern of opioid and benzodiazepine substitutes among Medicare part D beneficiaries from 2013 to 2018: a retrospective study. BMJ Open. 2021;11(11): e053487. https://doi.org/10.1136/bmjopen-2021-053487.CrossRefPubMedPubMedCentral

44.

American Geriatrics Society Panel on the Pharmacological Management of Persistent Pain in Older Persons. Pharmacological management of persistent pain in older persons. J Am Geriatr Soc. 2009;57(8):1331–46. https://doi.org/10.1111/j.1532-5415.2009.02376.x.CrossRef

45.

Paice JA, et al. Management of chronic pain in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2016;34(27):3325–45. https://doi.org/10.1200/jco.2016.68.5206.CrossRefPubMed

46.

Gibson DC, et al. Risk of an opioid-related emergency department visit or hospitalization among older breast, colorectal, lung, and prostate cancer survivors. Mayo Clin Proc. 2022;97(3):560–70. https://doi.org/10.1016/j.mayocp.2021.08.030.CrossRefPubMed

47.

Vu JV, et al. Statewide implementation of postoperative opioid prescribing guidelines. N Engl J Med. 2019;381(7):680–2. https://doi.org/10.1056/nejmc1905045.CrossRefPubMedPubMedCentral

48.

Simon AU, Collins CER. Lifestyle Redesign^® for chronic pain management: a retrospective clinical efficacy study. Am J Occup Ther. 2017;71(4):7104190040p1–7. https://doi.org/10.5014/ajot.2017.025502.CrossRef

49.

Frogner BK, et al. Physical therapy as the first point of care to treat low back pain: an instrumental variables approach to estimate impact on opioid prescription, health care utilization, and costs. Health Serv Res. 2018;53(6):4629–46. https://doi.org/10.1111/1475-6773.12984.CrossRefPubMedPubMedCentral

50.

Pritchard KT, Baillargeon J, Raji MA, Chou LN, Downer B, Kuo YF. Association of occupational and physical therapy with duration of prescription opioid use after hip or knee arthroplasty: a retrospective cohort study of medicare enrollees. Arch Phys Med Rehabil. 2021;102(7):1257–1266. https://doi.org/10.1016/j.apmr.2021.01.086.CrossRefPubMedPubMedCentral

Titel: Incident Functional Limitations Among Community-Dwelling Adults Using Opioids: A Retrospective Cohort Study Using a Propensity Analysis with the Health and Retirement Study
verfasst von: Kevin T. Pritchard
Brian Downer
Mukaila A. Raji
Jacques Baillargeon
Yong-Fang Kuo
Publikationsdatum: 17.06.2022
Verlag: Springer International Publishing
Erschienen in: Drugs & Aging / Ausgabe 7/2022
Print ISSN: 1170-229X
Elektronische ISSN: 1179-1969
DOI: https://doi.org/10.1007/s40266-022-00953-y

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Incident Functional Limitations Among Community-Dwelling Adults Using Opioids: A Retrospective Cohort Study Using a Propensity Analysis with the Health and Retirement Study