Abstract
Background 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. Methods 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. Results 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. Conclusion 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.
| Original language | English |
|---|---|
| Article number | e0210341 |
| Journal | PLoS ONE |
| Volume | 14 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 2019 |
Bibliographical note
Publisher Copyright:© 2019 Oh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding
This study was supported in part by grant R01AG054130 to DCM from the National Institute on Aging. There was no additional external funding received for this study. The NACC database is funded by NIA/NIH Grant U01 AG016976. NACC data are contributed by the NIA-funded. ADCs: P30 AG019610 (PI Eric Reiman, MD), P30 AG013846 (PI Neil Kowall, MD), P50 AG008702 (PI Scott Small, MD), P50 AG025688 (PI Allan Levey, MD, PhD), P50 AG047266 (PI Todd Golde, MD, PhD), P30 AG010133 (PI Andrew Saykin, PsyD), P50 AG005146 (PI Marilyn Albert, PhD), P50 AG005134 (PI Bradley Hyman, MD, PhD), P50 AG016574 (PI Ronald Petersen, MD, PhD), P50 AG005138 (PI Mary Sano, PhD), P30 AG008051 (PI Thomas Wisniewski, MD), P30 AG013854 (PI M. Marsel Mesulam, MD), P30 AG008017 (PI Jeffrey Kaye, MD), P30 AG010161 (PI David Bennett, MD), P50 AG047366 (PI Victor Henderson, MD, MS), P30 AG010129 (PI Charles DeCarli, MD), P50 AG016573 (PI Frank LaFerla, PhD), P50 AG005131 (PI James Brewer, MD, PhD), P50 AG023501 (PI Bruce Miller, MD), P30 AG035982 (PI Russell Swerdlow, MD), P30 AG028383 (PI Linda Van Eldik, PhD), P30 AG053760 (PI Henry Paulson, MD, PhD), P30 AG010124 (PI John Trojanowski, MD, PhD), P50 AG005133 (PI Oscar Lopez, MD), P50 AG005142 (PI Helena Chui, MD), P30 AG012300 (PI Roger Rosenberg, MD), P30 AG049638 (PI Suzanne Craft, PhD), P50 AG005136 (PI Thomas Grabowski, MD), P50 AG033514 (PI Sanjay Asthana, MD, FRCP), P50 AG005681 (PI John Morris, MD), P50 AG047270 (PI Stephen Strittmatter, MD, PhD). We thank Dr. I-Chen Chen and Dr. Bobby Jones for assistance with GBTM modeling.
| Funders | Funder number |
|---|---|
| National Institutes of Health (NIH) | U01 AG016976 |
| National Institutes of Health (NIH) | |
| National Institute on Aging | P30AG035982 |
| National Institute on Aging | |
| National Association for Colitis and Crohn's Disease | P30 AG013846, P30 AG028383, P30 AG008017, P30 AG053760, P30 AG010133, P50 AG005146, P50 AG033514, P50 AG005142, P50 AG005681, P50 AG047366, P50 AG047266, P30 AG019610, P50 AG023501, P30 AG008051, P30 AG010129, P30 AG013854, P50 AG005138, P50 AG008702, P30 AG010124, P30 AG012300, P50 AG005134, P50 AG005136, P50 AG025688, P50 AG047270, P30 AG035982, P30 AG010161, P50 AG005131, P50 AG005133, P30 AG049638, P50 AG016574, P50 AG016573 |
| National Association for Colitis and Crohn's Disease | |
| Universidad Complutense de Madrid | R01AG054130 |
| Universidad Complutense de Madrid | |
| Gujarat Biodiversity Board |
ASJC Scopus subject areas
- General
