Opiate Prescribing in Hospitalized Older Adults: Patterns and Outcomes

Abstract

Background/Objectives Whereas opiate prescribing patterns have been well described in outpatient and emergency department settings, they have been less defined in hospitalized older adults. The objective was to describe patterns of opiate prescribing and associated outcomes in hospitalized older adults. Design Retrospective cohort study. Setting Tertiary care facility. Participants Hospitalized medical patients aged 65 and older (N = 9,245; mean age 80.3, 55.2% female, 72.3% white, 90.8% non‐Hispanic). Measurements Opiate exposure and duration of action, concurrent use of potentially inappropriate medications (PIMs), adverse events, discharge disposition, length of stay (LOS), and 30‐day readmissions. Results There was no difference in sex, race, ethnicity, or Charlson Comorbidity Index between opiate exposure groups. Participants who had never received opiates had a significantly shorter mean LOS than prior and new opiate users (5.2, 6.8, 7.7 days; P < .001) and were more likely to be discharged home (88.6%, 82.8%, 82.5%; P < .001) and significantly less likely to be readmitted within 30‐days (19.6%, 25.0%, 22.3%; P < .001). Participant who had never been exposed to opiates had a significantly shorter mean LOS than those receiving short‐ and long‐acting opiates (5.2, 7.3, 8.6 days; P < .001) and were more likely to be discharged home (88.6%, 82.6%, 82.4%; P < .001) and significantly less likely to be readmitted within 30‐days (19.6%, 27.7%, 28.9%; P < .001). Conclusion Opiate use is widespread during hospitalization and is associated with significant negative clinical outcomes and quality metrics. There is an urgent need to develop innovative pain management alternatives to opiate use.

Prevalence and Characteristics of Moderate to Severe Pain among Hospitalized Older Adults

“…Other samples of hospitalized individuals have been smaller, investigated specific analgesics (e.g., opioids), or included more heterogeneous groups (e.g., mixed age groups or combined medical and surgical patients). [34][35][36][37] Although the prevalence identified in our study (20%) was lower than estimates of pain in community-dwelling adults (24-72%), [2][3][4] it is likely that this difference is because we focused on moderate to severe pain, whereas other studies Figure 3. Flow chart of opioid prescription before hospitalization, during hospitalization, and at discharge.…”

“…Opioid therapy is one of the most frequently implicated medications in adverse drug reactions in the hospital . A recent study showed that hospitalized older adults who received opioids had longer hospital stays and were more likely to be readmitted . In our study, participants who had received outpatient opioids before hospitalization experienced longer hospital stays than those who did not.…”

“…Our study offers a unique focus on management of moderate to severe pain in older medical patients. Other samples of hospitalized individuals have been smaller, investigated specific analgesics (e.g., opioids), or included more heterogeneous groups (e.g., mixed age groups or combined medical and surgical patients) . Although the prevalence identified in our study (20%) was lower than estimates of pain in community‐dwelling adults (24–72%), it is likely that this difference is because we focused on moderate to severe pain, whereas other studies reported any level of pain.…”

“…44 A recent study showed that hospitalized older adults who received opioids had longer hospital stays and were more likely to be readmitted. 37 In our study, participants who had received outpatient opioids before hospitalization experienced longer hospital stays than those who did not. Further research is necessary to clarify the effect of opioid use in this population and to identify nonopioid strategies for pain management in the hospital.…”

Multimorbidity and Opioid Prescribing in Hospitalized Older Adults

“…13 Studies of opioid-related adverse events in surgical inpatients suggest an association between older age, comorbidity severity, and opioid-related adverse events. [14][15][16] Nevertheless, multimorbidity remains an understudied and under-recognized reality in pain treatment guidelines. 2 Despite the high prevalence of pain and multimorbidity in older adults, little is known about patterns of analgesic treatment for these patients, particularly in the medical inpatient setting.…”