The patterns and burden of multimorbidity in geriatric patients with prolonged use of addictive medications

Abstract

Background Multimorbidity and prolonged use of addictive medications are prevalent among older patients, and known to increase the risk of adverse drug events. Yet, the relationship between these two entities has remained understudied. Aims This study explored the association between multimorbidity burden and prolonged use of addictive medications in geriatric patients, adjusted for clinically important covariates. Furthermore, we identified comorbidity patterns in prolonged users. Methods We conducted a cross-sectional study on a consecutive sample of 246 patients, aged 65–90 years, admitted to a large public university hospital in Norway. We defined prolonged use of addictive medications as using benzodiazepines, opioids and/or z-hypnotics beyond the duration recommended by clinical guidelines (≥ 4 weeks). Multimorbidity was assessed with the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), based on diagnoses made by independent physicians. Results Compared to non-prolonged use, prolonged use was significantly more common among patients who had psychiatric (19/27, 70%), liver (19/22, 86%), upper gastrointestinal tract (21/32, 66%), musculoskeletal (52/96, 54%), or nervous system disorders (46/92, 50%). Patients with prolonged use had a higher multimorbidity burden than those without such use (CIRS-G score, mean = 7.7, SD = 2.7 versus mean = 4.6, SD = 2.2, p < 0.001). Multivariable logistic regression indicated a significant association between multimorbidity burden and prolonged addictive medication use (OR = 1.72, 95% CI 1.42–2.08). Predictive margins postestimation showed a systematic increase in the predicted CIRS-G scores when the number of addictive drug used increases. Conclusions Multimorbidity is strongly associated with prolonged use of addictive medications. Multiple substance use may aggravate disease burden of older patients.

Validation of the Internal Coherence Scale (ICS) in Healthy Geriatric Individuals and Patients Suffering from Diabetes Mellitus Type 2 and Cancer

“…With increasing age, item inter-correlations, especially for the “inner resilience and coherence subscale” (subscale 1), dissolved. Reasons for lower correlations are the prospect of a shorter remaining lifespan, combined with simultaneously experiencing multimorbidity and functional limitations, which can lead to the use of polypharmacy [ 4 ] and prolonged addictive medication [ 5 ]. In a recent study, polypharmacy has been found to be strongly associated with disease burden in geriatric individuals [ 5 ].…”

“…Reasons for lower correlations are the prospect of a shorter remaining lifespan, combined with simultaneously experiencing multimorbidity and functional limitations, which can lead to the use of polypharmacy [ 4 ] and prolonged addictive medication [ 5 ]. In a recent study, polypharmacy has been found to be strongly associated with disease burden in geriatric individuals [ 5 ]. It is likely that the prospect of not being able to restore health negatively reflects on coherence and less stable ICS scores.…”

“…Conversely, as life expectancy increases, older people suffer longer or later in life from chronic somatic conditions (e.g., coronary heart disease, Diabetes Mellitus Type 2 and/or cancer), co- and multimorbidity and functional limitations [ 3 ]. Recent studies among the elderly show that multimorbidity in this population increases the risk of polypharmacy [ 4 ], the use of addictive medication such as neuroleptics and benzodiazepine [ 5 ], and the likelihood to experience depression [ 6 , 7 ], anxiety and stress [ 8 ]. Additionally, multimorbidity can lead to feelings of elevated interpersonal dependency [ 9 ] and poor health-related quality of life (HRQL) [ 10 ].…”

The effect of cognitive function and central nervous system depressant use on mortality—A prospective observational study of previously hospitalised older patients

“…Comorbidity was not an independent predictor of mortality, which is in contrast to other research [ 5 , 7 ]. This discrepancy might be related to prolonged CNSD use being associated with comorbidity, [ 28 ], but with uncertain causal direction of the relationship. Furthermore, both CNSDs and comorbidity influences cognitive function in older patients [ 30 , 48 ].…”

“…However, the relationship between somatic comorbidity, cognitive function and prolonged use of CNSDs is difficult to determine. This is especially related to the link between comorbidity and CNSD use [ 28 ], which both affects cognitive function [ 29 , 30 ]. Overall, further studies are needed to establish whether patients with and without reduced cognitive function, and prolonged use of CNSDs are at risk of increased likelihood of death.…”