Priority-Setting to Address the Geriatric Pharmacoparadox for Pain Management: A Nursing Home Stakeholder Delphi Study

Lapane, Kate L.; Dubé, Catherine; Hume, Anne L.; Tjia, Jennifer; Jesdale, Bill M.; Pawasauskas, Jayne; Khodyakov, Dmitry

doi:10.1007/s40266-021-00836-8

Cited by 8 publications

(16 citation statements)

References 37 publications

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“…Our observations regarding opioid use among residents with no assessed pain and/or no pain-related conditions also indicate potentially inappropriate use in need of further investigation. Our findings echo those of others [ 42 ] calling for significant clinical and policy changes in LTC to improve the recognition, assessment, and management of non-cancer pain. The increasing prevalence of pain and clinical complexity of LTC residents also illustrates the urgency for robust investigations of the safety and effectiveness of pain management strategies in this care setting.…”

Section: Discussionsupporting

confidence: 87%

“…Though this observation may support the latter interpretation, there may be other plausible clinical reasons for lower opioid use among residents coming from home. Additional research is needed to understand the up-stream drivers and appropriateness of analgesic and other pain management strategies among older adults entering LTC, given potential concerns about timely medication reconciliation and pain assessment among those newly admitted to LTC [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

“…While it is well recognized that pain is often poorly detected among residents who face challenges in expressing and/or communicating their pain symptoms to staff and family [ 1 , 3 , 8 , 18 – 20 ], this does not fully explain the lower use of opioids evident among residents with dementia across pain strata. There may be a reluctance to use opioids for pain management, even when otherwise indicated, among those with dementia because of concerns about medication risks [ 7 , 42 ]. We did observe a slightly higher adjusted prevalence of opioid use for residents with the highest level of cognitive impairment and pain intensity.…”

Section: Discussionmentioning

confidence: 99%

“…Frailty status has been relatively unexplored in LTC studies of analgesic use [ 2 ] despite being associated with pain and pain-related conditions [ 46 ] and its relevance to understanding the balance between benefit and risk for many medications [ 42 , 47 , 48 ]. Contrary to our hypothesis, frailty showed a statistically significant though modest positive association with opioid use overall and among residents assessed with no pain.…”

Section: Discussionmentioning

confidence: 99%

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Correlates of Opioid Use Among Ontario Long-Term Care Residents and Variation by Pain Frequency and Intensity: A Cross-sectional Analysis

et al. 2022

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Background Chronic non-cancer pain is common among older residents of long-term care (LTC) homes and often poorly recognized and treated. With heightened concerns regarding opioid prescribing in recent years, it is important to examine the current prevalence of opioid use and its association with resident characteristics to help identify those potentially at risk of medication harms as well as suboptimal pain management. Objectives The aims were to estimate the prevalence and correlates of opioid use among non-palliative LTC residents and explore variation in opioid prevalence and correlates across strata defined by pain frequency and intensity. Methods We conducted a population-based cross-sectional study of all older (aged > 65 years) LTC residents (excluding those with cancer or receiving palliative care) in Ontario, Canada during 2018–2019. Health administrative databases were linked with standardized clinical assessment data to ascertain residents’ health and pain characteristics and their opioid and other medication use. Modified Poisson regression models estimated unadjusted and adjusted associations between residents’ characteristics and opioid use, overall and across strata capturing pain frequency and intensity. Results Among 75,020 eligible residents (mean age 85.1 years; 70% female), the prevalence of opioid use was 18.5% and pain was 29.4%. Opioid use ranged from 12.2% for residents with no current pain to 55.7% for those with severe pain. In adjusted models, residents newly admitted to LTC (adjusted risk ratio [aRR] = 0.60, 95% confidence interval [CI] 0.57–0.62) and with moderate to severe cognitive impairment (aRR = 0.69, 95% CI 0.66–0.72) or dementia (aRR = 0.76, 95% CI 0.74–0.79) were significantly less likely to receive an opioid, whereas residents with select conditions (e.g., arthritis, aRR = 1.37, 95% CI 1.32–1.41) and concurrently using gabapentinoids (aRR = 1.80, 95% CI 1.74–1.86), benzodiazepines (aRR = 1.33, 95% CI 1.28–1.38), or antidepressants (aRR = 1.31, 95% CI 1.27–1.35) were significantly more likely to receive an opioid. The associations observed for residents newly admitted, with dementia, and concurrently using gabapentinoids, benzodiazepines, or antidepressants were largely consistent across all pain strata. Conclusions Our findings describe resident sub-groups at potentially higher risk of adverse health outcomes in relation to both opioid use and non-use. LTC clinical and policy changes informed by research are required to ensure the appropriate recognition and management of non-cancer pain in this setting. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-022-00972-9.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Correlates of Opioid Use Among Ontario Long-Term Care Residents and Variation by Pain Frequency and Intensity: A Cross-sectional Analysis

et al. 2022

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“…Sixty-four records fulfilled our inclusion criteria 16–79. Of these records, 51 were full-text studies, 12 were conference abstracts and 1 was a poster.…”

Section: Resultsmentioning

confidence: 99%

Research priority setting related to older adults: a scoping review to inform the Cochrane-Campbell Global Ageing Partnership work programme

et al. 2022

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ObjectiveTo explore and map the findings of prior research priority-setting initiatives related to improving the health and well-being of older adults.DesignScoping review.Data sourcesSearched MEDLINE, EMBASE, AgeLine, CINAHL and PsycINFO databases from January 2014 to 26 April 2021, and the James Lind Alliance top 10 priorities.Eligibility criteriaWe included primary studies reporting research priorities gathered from stakeholders that focused on ageing or the health of older adults (≥60 years). There were no restrictions by setting, but language was limited to English and French.Data extraction and synthesisWe used a modified Reporting Guideline for Priority Setting of Health Research (REPRISE) guideline to assess the transparency of the reported methods. Population–intervention–control–outcome (PICO) priorities were categorised according to their associated International Classification of Health Interventions (ICHI) and International Classification of Functioning (ICF) outcomes. Broad research topics were categorised thematically.ResultsSixty-four studies met our inclusion criteria. The studies gathered opinions from various stakeholder groups, including clinicians (n=56 studies) and older adults (n=35), and caregivers (n=24), with 75% of the initiatives involving multiple groups. None of the included priority-setting initiatives reported gathering opinions from stakeholders located in low-income or middle-income countries. Of the priorities extracted, 272 were identified as broad research topics, while 217 were identified as PICO priorities. PICO priorities that involved clinical outcomes (n=165 priorities) and interventions concerning health-related behaviours (n=59) were identified most often. Broad research topics on health services and systems were identified most often (n=60). Across all these included studies, the reporting of six REPRISE elements was deemed to be critically low.ConclusionFuture priority setting initiatives should focus on documenting a more detailed methodology with all initiatives eliciting opinions from caregivers and older adults to ensure priorities reflect the opinions of all key stakeholder groups.

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Greater Opioid Use Among Nursing Home Residents in Ontario, Canada During the First 2 Waves of the COVID-19 Pandemic

Maxwell

Campitelli

Cotton

et al. 2022

Journal of the American Medical Directors Association

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Priority-Setting to Address the Geriatric Pharmacoparadox for Pain Management: A Nursing Home Stakeholder Delphi Study

Cited by 8 publications

References 37 publications

Correlates of Opioid Use Among Ontario Long-Term Care Residents and Variation by Pain Frequency and Intensity: A Cross-sectional Analysis

Correlates of Opioid Use Among Ontario Long-Term Care Residents and Variation by Pain Frequency and Intensity: A Cross-sectional Analysis

Research priority setting related to older adults: a scoping review to inform the Cochrane-Campbell Global Ageing Partnership work programme

Greater Opioid Use Among Nursing Home Residents in Ontario, Canada During the First 2 Waves of the COVID-19 Pandemic

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