Patterns and predictors of chronic opioid use in older adults: A retrospective cohort study
Patterns and predictors of chronic opioid use in older adults: A retrospective cohort study
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DOI：
10.1371/journal.pone.0210341
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发表时间：
2019-01-11
期刊：
影响因子：
3.7
通讯作者：
Moga, Daniela C.
中科院分区：
文献类型：
--
作者：
Oh, Gyeon;Abner, Erin L.;Moga, Daniela C.
BackgroundGiven的争议阿片类药物治疗慢性疼痛的有效性和缺乏详细的指导处方阿片类药物在老年人，本研究的目的是估计阿片类药物使用的轨迹和预测因素在老年人。MethodsData提取自国家阿尔茨海默氏症协调中心（2005-2017）。基于群组的轨迹建模用于识别65岁以上参与者使用阿片类药物的模式（任何或强烈）。我们使用多变量logistic回归向后选择，以评估人口统计学和合并症的轨迹membership.ResultsAmong 13，059参与者的潜在预测因素，四个轨迹被确定为使用任何阿片类药物和强阿片类药物（最小用户，事件慢性用户，停止用户，和流行的慢性用户）。对于任何阿片类药物，女性（校正比值比= 1.23; 95%置信区间= 1.03-1.46），黑人vs.白色（1.47; 1.18-1.82），受教育年限（0.96; 0.94-0.99），居住类型（独立组与私立组：1.77; 1.38-2.26，护理机构与私立组：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），用药次数（1至4对无：0.48; 0.36-0.64，5或以上对无：0.67; 0.50-0.88）和抗抑郁药（1.38; 1.14-1.67）与事件慢性使用对不使用相关。对于强效阿片类药物，女性（1.27; 1.04-1.56），居住类型（独立组与私立组：1.90; 1.43-2.53，护理机构与私立组：2.37; 1.44-3.90），目前吸烟（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），用药次数（1至4对无：0.46; 0.32-0.65，5或更多对无：0.59; 0.42-0.83），和抗抑郁剂（1.55; 1.24-1.93）与事件慢性使用与不使用有关。结论鉴于慢性阿片类药物使用在更脆弱的参与者中更普遍（即，年龄较大、有多种合并症和多种药物），进一步的研究应评估在这一人群中使用阿片类药物的安全性和有效性。
BackgroundGiven 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.MethodsData 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.ResultsAmong 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.ConclusionGiven 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.