Abstract
Objectives
To examine the association between use of opioids versus other analgesics with death
and functioning after hip fracture in older nursing home (NH) residents.
Design
Retrospective cohort using national Medicare fee-for-service claims linked to the
Minimum Data Set.
Setting
US NHs.
Participants
NH residents aged ≥65 years who became a long-stay resident (>100 days in the NH)
between January 2008 and December 2009, had a hospitalized hip fracture, and returned
to the NH.
Exposure
New use of opioid versus nonopioid analgesics (acetaminophen or nonsteroidal anti-inflammatory
drugs) within 14 days post hip fracture.
Measurements
Follow-up began on the index date and continued until the first occurrence of death,
significant functional decline (3-point increase on MDS Activities of Daily Living
scale), or 120 days of follow-up. Odds ratios (ORs) with 95% confidence intervals
(CIs) for outcomes were estimated using inverse probability of treatment–weighted
multinomial logistic regression models.
Results
Among the 2755 NH residents with a hip fracture included in our study, 1155 (41.9%)
were opioid users, and 1600 (58.1%) were nonopioid analgesic users. The mean age was
86.3 years, 73.8% were female, and 86.0% were white. Opioid use was associated with
a significantly lower likelihood of death (OR = 0.47, 95% CI 0.39-0.56) and a nonsignificant
decrease in functional decline (OR = 0.77, 95% CI 0.58-1.03).
Conclusion
A rigorous study that addresses the limitations of this study is critical to validate
our preliminary findings and provide evidence about the effect of using opioid versus
nonopioid analgesics to optimize acute pain in NH residents with a hip fracture.
Keywords
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Article info
Publication history
Published online: December 26, 2017
Identification
Copyright
Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
