Dataset Information

Geographical Variation in Opioid Use in Elderly Patients with Dementia: A Nationwide Study.

ABSTRACT:

Background

We recently reported frequent use of opioids among elderly with dementia. Discrepancies in clinical practice may in part explain the higher use of opioids in elderly with dementia, which geographical variation may be able to clarify.

Objective

To investigate geographical variation in opioid use in elderly with dementia compared to elderly without dementia.

Methods

Register-based cross-sectional study in the entire elderly (?65 years) population of Denmark in 2015. Data included place of residence, prescriptions, and discharge diagnoses from hospital contacts. Prevalence of opioid use among elderly with (n?=?36,014) and without dementia (n?=?1,011,787) was compared nationwide across the five Danish regions using logistic regression analysis and for the 98 municipalities using age and sex standardization.

Results

32.5% of elderly with dementia and 16.9% without were treated with an opioid in 2015. For home-living elderly with dementia, there was a 4-fold difference in opioid use (9.4 to 36.8%) between municipalities compared to a 1.6-fold (12.7 to 20.2%) difference for elderly without. In nursing home residents there was a 2-fold difference (dementia: 26.5 to 55.2%; no dementia: 31.8 to 60.4%). Differences between the five regions were minor.

Conclusion

Opioid use in elderly with dementia was frequent and almost twice as high compared to elderly without dementia, which may challenge patient safety. The pronounced geographical variations at municipality level, particularly among elderly with dementia, indicate differences in the approach to treatment of chronic pain in primary care. Our study suggests that more guidance on treatment of pain in elderly with dementia is needed.

SUBMITTER: Jensen-Dahm C

PROVIDER: S-EPMC6839457 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Geographical Variation in Opioid Use in Elderly Patients with Dementia: A Nationwide Study.

Jensen-Dahm Christina C Zakarias Johanne Købstrup JK Gasse Christiane C Waldemar Gunhild G

Journal of Alzheimer's disease : JAD 20190101 4

<h4>Background</h4>We recently reported frequent use of opioids among elderly with dementia. Discrepancies in clinical practice may in part explain the higher use of opioids in elderly with dementia, which geographical variation may be able to clarify.<h4>Objective</h4>To investigate geographical variation in opioid use in elderly with dementia compared to elderly without dementia.<h4>Methods</h4>Register-based cross-sectional study in the entire elderly (≥65 years) population of Denmark in 2015 ...[more]

PMID: 31322575

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Project description:PurposeHip fractures are a common health problem among the elderly with an increasing incidence. They are associated with high mortality and morbidity. Optimal pain management remains challenging and inadequate pain control is known for negatively affecting outcomes. Loco-regional anaesthetics (LRA) have been proven to benefit pain management and to lower the risks of opioid use and -related side effects. We aimed to evaluate the use and efficacy of different LRA in elderly hip fracture patients.MethodsSingle-center cohort study of elderly hip fracture patients, who were treated in central Switzerland. We compared patients who received LRA in the form of a femoral nerve block (FNB) or a continuous femoral nerve catheter (CFNC) with patients who did not receive LRA. Primary outcomes were pain-as measured in perioperative morphine use-hospital length of stay (HLOS), postoperative complications, postoperative falls and mortality.Results407 patients were included for analysis. Mean age was 85.2 (SD6.3). There was a significant difference in intraoperative morphine use between the groups (p = 0.007). Postoperative morphine use differed significantly and was lowest in patients with FNB and highest in patients without LRA (p < 0.001). The use of LRA was a significant predictor for postoperative morphine use for postoperative morphine use at the recovery room and for postoperative morphine use 48 h after surgery. No significant differences were found in postoperative complications, a significant difference was found in 1-year mortality.ConclusionsThis article shows that LRA in the form of FNB and CFNC causes a significant decrease in postoperative opioid consumption. Differences between single-shot FNB or CFNC were minimal. There were no significant differences in clinical outcomes such as HLOS, delirium, 30-day and 90-day mortality and postoperative falls. We suggest that use of LRA should be incorporated in the perioperative treatment of elderly patients with a hip fracture. For future research, we recommend evaluating the number of postoperative complications and mortality.

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Dataset Information

Geographical Variation in Opioid Use in Elderly Patients with Dementia: A Nationwide Study.

Background

Objective

Methods

Results

Conclusion

Publications

Geographical Variation in Opioid Use in Elderly Patients with Dementia: A Nationwide Study.

Similar Datasets

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