Time Trends in Opioid Use by Dementia Severity in Long-Term Care Nursing Home Residents.
Time Trends in Opioid Use by Dementia Severity in Long-Term Care Nursing Home Residents.
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DOI：
10.1016/j.jamda.2020.04.029
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发表时间：
2021-01
影响因子：
7.6
通讯作者：
Goodwin JS
中科院分区：
文献类型：
--
作者：
Mehta HB;Kuo YF;Raji M;Li S;Westra J;Goodwin JS
目前关于养老院居民，特别是痴呆症患者使用阿片类药物的信息尚不清楚。我们研究了阿片类药物使用的痴呆严重程度的时间趋势和长期护理养老院居民的痴呆严重程度与阿片类药物使用的相关性。使用2011-2017年的20%最小数据集（MDS）和医疗保险索赔，我们纳入了每年连续住院120天的长期护理居民（n= 734，739）。在二次分析中，我们纳入了因骨折而急诊室就诊的居民（n= 12，927）。根据每年第一次MDS评估，将痴呆分为无、轻度、中度和重度。在120天的疗养院住宿中，阿片类药物的使用被测量为任何，长期（>90天）和高剂量（≥90吗啡毫克当量剂量/天）。对于骨折的居民，在急诊室出院后7天内测量阿片类药物的使用情况。使用logistic回归评估痴呆严重程度与阿片类药物使用的相关性。总体而言，从2011年到2017年，任何阿片类药物的使用下降了8.4%（35.2%至32.2%，p <0.001），长期使用下降了4.6%（14.1%至13.4%，p <0.001），高剂量下降了19.7%（1.4%至1.1%，p<0.001）。阿片类药物的使用在四个痴呆严重程度组中下降。在骨折的居民中，阿片类药物的使用在轻度痴呆中下降了9%，中度痴呆中下降了9.5%，重度痴呆中下降了12.3%。接受任何，长期和高剂量阿片类药物的几率随着痴呆严重程度的增加而降低。例如，重度痴呆降低了任何（23.5% vs. 47.6%; OR=0.56，95%CI=0.55-0.57），长期（9.8% vs. 20.7%; OR=0.69，95%CI=0.67-0.71）和高剂量（1.0% vs. 2.3%; OR=0.69，95%CI=0.63-0.74）阿片类药物的几率。从2011年到2017年，养老院居民使用阿片类药物的情况有所下降，痴呆症居民的使用率较低，这可能反映了该人群的疼痛管理不佳。这项具有全国代表性的研究发现，从2011年到2017年，养老院居民的阿片类药物使用量下降，痴呆症患者的使用量较低。
Current information on opioid use in nursing home residents, particularly those with dementia, is unknown. We examined the temporal trends in opioid use by dementia severity and the association of dementia severity with opioid use in long-term care nursing home residents. Repeated measures cross-sectional study Long-term care nursing homes Using 20% Minimum Data Set (MDS) and Medicare claims from 2011–2017, we included long-term care residents (n=734,739) from each year who had 120 days of consecutive stay. In a secondary analysis, we included residents who had an emergency room visit for a fracture (n=12,927). Dementia was classified as no, mild, moderate and severe based on the first MDS assessment each year. In the 120 days of nursing home stay, opioid use was measured as any, prolonged (>90 days) and high-dose (≥90 morphine milligram equivalent dose/day). For residents with a fracture, opioid use was measured within 7 days after emergency room discharge. Association of dementia severity with opioid use was evaluated using logistic regression. Overall, any opioid use declined by 8.4% (35.2% to 32.2%, p<0.001), prolonged use by 4.6% (14.1% to 13.4%, p<0.001) and high-dose by 19.7% (1.4% to 1.1%, p<0.001) from 2011 to 2017. Opioid use declined across four dementia severity groups. Among residents with fracture, opioid use declined by 9% in mild, 9.5% in moderate and 12.3% in severe dementia. The odds of receiving any, prolonged and high-dose opioids decreased with increasing severity of dementia. For example, severe dementia reduced the odds of any (23.5% vs. 47.6%; OR=0.56, 95%CI=0.55–0.57), prolonged (9.8% vs. 20.7%; OR=0.69, 95%CI=0.67–0.71) and high-dose (1.0% vs. 2.3%; OR=0.69, 95%CI=0.63–0.74) opioids. Use of opioids declined in nursing home residents from 2011 to 2017, and the use was lower in residents with dementia, possibly reflecting suboptimal pain management in this population. This nationally representative study found that opioid use declined in nursing home residents from 2011 to 2017, and the use was lower in residents with dementia.
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影响因子：
6.3
作者：
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