Health-related quality of life in hospitalized older patients with versus without prolonged use of opioid analgesics, benzodiazepines, and z-hypnotics: a cross-sectional study

Abstract

Background Central nervous system depressant medications (CNSDs) such as opioid analgesics and sedative-hypnotics are commonly prescribed to older patients for the treatment of chronic pain, anxiety and insomnia. Yet, while many studies reported potential harms, it remains unknown whether persistent use of these medications is beneficial for older patients’ self-reported health-related quality of life (HRQoL). The present study clarified this knowledge gap through comparing HRQoL of hospitalized older patients with versus without using CNSD drugs for ≥4 weeks. Moreover, we explored the relationship between such use and HRQoL, adjusting for the effects of polypharmacy, comorbidity burden and other clinically relevant covariates. Methods The study was cross-sectional and included 246 older patients recruited consecutively from somatic departments of a large regional university hospital in Norway. We defined prolonged CNSD use as using opioids, benzodiazepines and/or z-hypnotics for ≥4 weeks. Patients’ self-reported HRQoL were measured with scales of the EuroQol EQ-5D-3L instrument. Data analyses were mainly descriptive statistics and regression models. Results Patients with prolonged use of CNSDs reported lower scores on both EQ-5D index and EQ VAS compared with those without such use (p < 0.001). They had higher odds of having more problems performing usual activities (OR = 3.37, 95% CI: 1.40 to 8.13), pain/discomfort (OR = 2.06, 95% CI: 1.05 to 4.04), and anxiety/depression (OR = 3.77, 95% CI: 1.82 to 7.82). In multivariable regression models, there was no significant association between prolonged CNSD use and HRQoL when including pain as a predictor variable. In models not including pain, CNSD use was strongly associated with HRQoL (adjusted for sociodemographic background, polypharmacy, comorbidity, anxiety and depressive symptoms, regression coefficient − 0.19 (95% CI, − 0.31 to − 0.06). Conclusions Older patients with prolonged CNSD use reported poorer HRQoL. They also had more pain and higher depression scores. Prolonged use of CNSDs was not independently associated with higher HRQoL.

Calidad de vida relacionada con la salud en pacientes consumidores de benzodiacepinas

“…Además, esta puntuación también ha sido inferior en quienes mostraron ansiedad o insomnio a pesar del tratamiento. En una investigación reciente 32 los pacientes de edad avanzada hospitalizados con uso prolongado de benzodiacepinas informaron de una peor CVRS, comprobándose puntuaciones más bajas respecto a los pacientes no tratados tanto en el índice EQ como en EQ-EVA.…”

UK Medical Cannabis Registry: Assessment of clinical outcomes in patients with insomnia

“…Limited evaluation of the use of hypnotics, such as benzodiazepines and Z‐drugs, in insomnia has failed to show any change in outcomes for HRQoL (Scalo et al., 2015). In other settings, high‐dose benzodiazepines have shown deleterious effects on HRQoL (Cheng et al., 2020; Tamburin et al., 2017). The associated improvement in HRQoL in this study is consistent with changes previously identified in a Canadian cohort who received medical cannabis for insomnia (Vaillancourt et al., 2022).…”

“…Limited evaluation of the use of hypnotics, such as benzodiazepines and Z-drugs, in insomnia has failed to show any change in outcomes for HRQoL (Scalo et al, 2015). In other settings, high-dose benzodiazepines have shown deleterious effects on HRQoL (Cheng et al, 2020;Tamburin et al, 2017).…”

Age-Related Risk of Serious Fall Events and Opioid Analgesic Use

“…CRs for this group were high among all dose categories, including the reference category, and covariates included in models likely disproportionately affected older individuals. Older people prescribed higher opioid doses may also be less mobile due to the sedating effects of opioids or the conditions for which these doses are indicated; moderate to severe pain and opioid use are associated with reduced mobility in older adults, [50][51][52] potentially translating to fewer opportunities for falling.…”