National study of injury‐increasing analgesics in the elderly

Abstract

PurposeThe purpose of this paper is to identify the probability of the occurrence of an analgesic medication injury when controlling for potential risk factors, as well as gain a better understanding of which risk factors appear more problematic.Design/methodology/approachCross‐sectional retrospective review of 2004 Centers for Medicare and Medicaid Service Medicaid Pharmacy claims data. Logistic regression analysis performed to examine the risk of injury‐related emergency room (ER) visits following the use of analgesics controlling for potential risk factors.FindingsMethadone, an agent to treat severe pain, and propoxyphene, an agent to treat non‐severe pain, are problematic opioids in the elderly. White origin, male gender, and increased disease burden are potential risk factors influencing injury‐related ER visits for elderly analgesic recipients. Increased age in the elderly is a potential risk factor for severe pain analgesics; decreased age for non‐severe pain analgesics.Research limitations/implicationsThe study uses administrative data which, by its nature, makes conducting outcomes research on inappropriate medication use problematic. A number of confounders are present.Practical implicationsAppropriate drug therapy in an elderly patient is complicated by age‐related changes in pharmacokinetics as well as chronic disorders that affect drug response. Knowing of additional risk factors that may place the patient at greater odds of having an adverse outcome should improve prescribing practices.Originality/valueThe findings add to the literature by identifying problematic risk factors associated with injury among elderly recipients of analgesics.

Analgesic Medicine Utilization in Older People in New Zealand from 2005 to 2013

“…Our study finding of increased analgesic utilization by females was consistent with Blackwell et al’s finding that females had higher analgesic refill rates compared with males and the results of two other studies, carried out in the USA and Manitoba [ 13 , 22 , 23 ]. A cross-sectional postal survey conducted in Scotland reported that females had a higher probability of using more non-prescription medicines, particularly analgesics, compared with males [ 24 ].…”

“…New Zealand Europeans showed the highest utilization compared with other groups (average DDD/TOPD of 257.45). Our results are supported by a study described by Blackwell et al [ 13 ], which showed that Europeans had a higher analgesic refill rate compared with other ethnic groups. A similar pattern was reported in a US population-based study conducted by Paulose-Ram et al [ 23 ], which showed a higher prevalence of non-prescription analgesics use among non-Hispanic whites; however, this study did not show any difference in the use of prescription analgesics between different ethnic groups.…”

“…Similarly, another population-based study, conducted in Helsinki, Finland, over a 10-year period (1989–1999), showed that the utilization of analgesic medicines was higher in the age group of 85+ compared with in those aged 75 years [ 19 ]. A study conducted by Blackwell et al [ 13 ] assessing the number of analgesic medications refills showed that people older than 85+ had the highest refill rate. In contrast, an investigation carried out in Italy showed that older adults aged 85+ were least likely to receive analgesic medications.…”

“…Older people are prone to experiencing adverse effects associated with analgesics compared with their younger counterparts [ 12 ]. Opioid analgesic use in older people may be associated with an increased risk of falls due to their adverse effects on the central nervous system, which include dizziness, sedation and/or syncope [ 12 , 13 ]. Polypharmacy is common in older people [ 12 , 14 ], and the concomitant use of analgesics can contribute to clinically significant drug–drug interactions and adverse reactions [ 14 ].…”

Applying the 2003 Beers Update to Elderly Medicare Enrollees in the Part D Program

“…Fourth, we construed the CMS-HCC risk scores as a proxy for patient disease burden, although they were originally developed as a measure of capitated payment prediction in Medicare Part C. However, these scores have been used previously as a measure of disease burden (Blackwell, Baugh, Montgomery, Ciborowski, & Levy, 2011) and compare favorably with the Charlson and Elixhauser methods as risk adjusters for mortality (Li, Kim, & Doshi, 2010).…”