Patterns and variation of opioid use in long-stay nursing home residents with dementia

摘要 痴呆症和阿片类药物流行是美国两个不断升级的公共卫生挑战。人中有一半以上 患有痴呆症的人经常感到疼痛。尽管老年人的疼痛识别和治疗有所改善， 在成年人中，痴呆症患者比没有痴呆症的人更不可能接受适当的止痛药。 阿片类药物的使用在过去十年中翻了两番，超过三分之一的养老院居民被开处方 阿片类药物。先前的研究表明，药物使用的变化（抗精神病药，抗抑郁药，抗生素 和他汀类药物）。目前尚不清楚阿片类药物如何用于护理之家的疼痛管理 患有痴呆症的居民，以及这种使用在养老院之间是否存在差异。为了弥补这一研究空白，我们 建议进行一项具有全国代表性的研究，以检查养老院居民使用阿片类药物的情况 患有痴呆症我们的具体目标是：1.描述阿片类药物使用的患病率、持续时间和剂量， 长期护理的老年痴呆症疗养院居民，与他们的疼痛水平有关。2.比较阿片类药物 在患有痴呆症的长期护理疗养院居民与非痴呆症居民之间的使用。3. 确定老年痴呆症长期护理居民中养老院阿片类药物使用的变化， 识别与此变化相关的患者、开处方者和机构级特征。我们将使用 本研究的最小数据集和2008年至2016年的医疗保险索赔数据。这项研究将提供 政策相关和临床有用的信息，以确保安全和有效地使用阿片类药物在养老院 老年痴呆症患者

ABSTRACT Dementia and the opioid epidemic are two escalating public health challenges in the US. Over half of those with dementia regularly experience pain. Despite improvement in pain recognition and treatment among older adults, dementia patients are less likely than those without dementia to receive appropriate pain medication. Opioid use has quadrupled in the last decade, with over one third of nursing home residents prescribed opioids. Prior studies have shown variations in medication use (for antipsychotics, antidepressants, antibiotics and statins) across nursing homes. It is unknown how opioids are used for pain management in nursing home residents with dementia and if such use varies across nursing homes. To address this research gap, we propose to conduct a nationally representative study to examine the use of opioids in nursing home residents with dementia. Our specific aims are: 1. Describe the prevalence, duration, and dose of opioid use among long-term care nursing home residents with dementia, related to their pain level. 2. Compare the rate of opioid use among long-term care nursing home residents with dementia to that of residents without dementia. 3. Determine the variation in opioid use across nursing homes among long-term care residents with dementia and identify the patient, prescriber and facility level characteristics associated with this variation. We will use the Minimum Data Set and Medicare claims data from 2008 to 2016 for this study. This research will provide policy-relevant and clinically useful information to ensure the safe and effective use of opioids in nursing home residents with dementia.