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P4‐634: ASSOCIATION OF DEMENTIA SEVERITY AND OPIOID USE IN LONG‐TERM CARE NURSING HOME RESIDENTS WITH DEMENTIA
Author(s) -
Mehta Hemalkumar B.,
Kuo Yong-Fang,
Westra Jordan,
Goodwin James S.,
Raji Mukaila
Publication year - 2019
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2019.08.183
Subject(s) - medicine , dementia , opioid , minimum data set , retrospective cohort study , cohort , logistic regression , emergency medicine , nursing homes , disease , nursing , receptor
Background: Pain may be under recognized and undertreated in dementia patients. We examined the prevalence, duration, and type of opioid use among long-term care nursing home residents with dementia. Methods: This retrospective cohort study used Minimum Data Set linked Medicare data, 2011-2016, and included longterm care episodes for residents 65+ years who survived 100+ days each year (592,211 episodes for 256,207 residents). Cognitive status at first annual assessment was classified as none/mild, moderate and severe impairment. Overall opioid use, prolonged opioid use (prescription supply 90+ days) and long-acting opioid use were identified fromMedicare part D. Descriptive statistics were used to describe opioid use by cognitive impairment. Cochrane Armitage trends test was used to determine trends in opioid use. Three separate logistic regression models were constructed to determine the association of cognitive impairment with any opioid use, prolonged opioid use and long-acting opioid use after controlling for age, race, region and pain level. Results: 114,622 (19%) patients had severe and 129,257 (22%) had moderate dementia. Overall opioid (none/mild1⁄415.4%, moderate1⁄413.9%, severe1⁄49%), prolonged opioid (none/mild1⁄45.2%, moderate1⁄44.5%, severe1⁄43.2%) and long-acting opioid use (none/mild1⁄41.1%, moderate1⁄40.9%, severe1⁄40.3% ) were lower in patients with advanced dementia. Substantial increase was found in overall opioid and prolonged opioid use from 2011 to 2016, with greater increase in none/mild and moderate dementia patients. For example, prolonged opioid use increased by 69% in none/mild and 71% in moderate dementia patients compared to 52% in severe dementia patients (p<0.0001). Long-acting opioid use decreased, with a greater decline in none/ mild (69%) and moderate (71%) dementia patients compared to severe dementia patients (58%) (p<0.0001). In logistic regression models, patient with moderate and severe cognitive impairment were associated with lower use of any opioid, prolonged opioid and long-acting opioid (Table 1). Conclusions: Contrary to decreasing opioid use in community setting, overall and prolonged opioid use increased in nursing home residents. Association between severe cognitive impairment and lower opioid use (independent of pain level) suggests possible under-recognition or undertreatment of pain in long-term care residents with dementia. Future studies should investigate if pain is appropriately treated in dementia patients. P4-636 THE ROLE OF SOCIAL STATUS AND CHRONIC STRESS FOR RACIAL DISPARITIES IN COGNITIVE AGING Rachel Peterson, Emily A. Butler, Mindy Joy Fain, John E. Ehiri, Scott C. Carvajal, University of Arizona Center on Aging, Tucson, AZ, USA; University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA; University of Arizona, Tucson, AZ, USA; University of Arizona College of Medicine, Division of Geriatrics, General Internal Medicine and Palliative Medicine, Tucson, AZ, USA; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA; Arizona Prevention Research Center, Tucson, AZ, USA. Contact e-mail: rpeterson@aging.arizona.edu