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Opioid Use After Hospital Care due to Hip Fracture Among Community-Dwelling Persons With and Without Alzheimer's Disease.

ABSTRACT: BACKGROUND:Hip fractures are common among persons with Alzheimer's disease (AD), but problems in pain assessment may lead to insufficient analgesia after hospitalization. OBJECTIVE:We investigated the prevalence of opioid use in the 6 months after discharge from hospital care due to hip fracture among community-dwellers with and without AD. SETTING AND METHOD:The Medication use and Alzheimer's disease (MEDALZ) cohort was used for this study, consisting of all community-dwelling persons newly diagnosed with AD during 2005-2011 in Finland and their comparison persons without AD matched on age, sex, and region of residence at the time of AD diagnosis. Data were collected from nationwide healthcare registers. MAIN OUTCOME MEASURES:We investigated opioid use versus non-use in persons with and without AD in the 6 months after discharge from hospital care due to hip fracture. RESULTS:Altogether 2342 persons with AD and 1615 persons without AD, discharged to community settings within???120 days after a hip fracture, were included. A higher percentage of persons with AD used opioids compared to those without AD, 39.5% [95% confidence interval (CI) 37.5-41.5] versus 31.2% (95% CI 28.9-33.5). Persons with AD used more frequently strong opioids during the first 3 months and buprenorphine during the 6-month period, and used weak opioids less frequently after the first month after discharge compared to those without AD. CONCLUSIONS:Frequent opioid use after hospital care due to hip fracture may indicate increased attention to pain among persons with AD. Nevertheless, the benefits and harms of opioid use should be evaluated regularly in community-dwelling older persons.

SUBMITTER: Lintula E

PROVIDER: S-EPMC7044157 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Opioid Use After Hospital Care due to Hip Fracture Among Community-Dwelling Persons With and Without Alzheimer's Disease.

Lintula Eveliina E Tiihonen Miia M Taipale Heidi H Tolppanen Anna-Maija AM Tanskanen Antti A Tiihonen Jari J Hartikainen Sirpa S Hamina Aleksi A

Drugs & aging 20200301 3

<h4>Background</h4>Hip fractures are common among persons with Alzheimer's disease (AD), but problems in pain assessment may lead to insufficient analgesia after hospitalization.<h4>Objective</h4>We investigated the prevalence of opioid use in the 6 months after discharge from hospital care due to hip fracture among community-dwellers with and without AD.<h4>Setting and method</h4>The Medication use and Alzheimer's disease (MEDALZ) cohort was used for this study, consisting of all community-dwel ...[more]

PMID: 31879863

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Project description:BackgroundHospital length of stays (LOS) for incident of hip fracture are decreasing, but it is unknown if these changes have negative impacts on vulnerable older patient populations, like those with Alzheimer's disease (AD). We aimed to assess if persons with and without AD have different hospital LOS for hip fracture, and is the LOS associated with hospital readmissions.MethodsUtilizing register-based data for a matched cohort study nested in the Medication use and Alzheimer's disease study (MEDALZ), we collected all community-dwelling persons in Finland diagnosed with AD during 2005-2012, had incident of first hip fracture between 2005 and 2015 after AD diagnosis, and were discharged alive from an acute care hospital. Hospital LOS and hospital readmissions within 30-days and 90-days were compared between those with and without AD and risk of readmission was assessed using binary logistic regression analysis.ResultsIn this matched cohort study of 12,532 persons (mean age 84.6 years (95% CI: 84.5-84.7), 76.8% women), the median LOS in an acute care hospital was 1 day shorter for those with AD (median 4 days, IQR 3-7) than those without AD (median 5 days, IQR 3-7) (P < 0.001). However, the AD cohort had respectively 6 days and 5 days longer median LOS in a community hospital, and total hospital stay compared to the non-AD cohort (P < 0.001 for all comparisons). Those with AD had fewer readmissions within 30-days (10.7%) and 90-days (16.9%) compared to those without AD (13.3% 30-days and 20.7% 90-days) (P < 0.001 for all comparisons). Both cohorts had a reduced readmission risk within 30-days when the LOS in an acute care hospital was 4-14 days, compared to a LOS less than 4 days.ConclusionsPersons with AD had shorter acute care hospital LOS, but had longer LOS in a community hospital setting compared to those without AD, which is similar to other findings when comparing total hospital LOS. These findings imply that short LOS in acute care hospitals may be associated with poor health outcomes for vulnerable older populations after hip fracture.

Project description:OBJECTIVES:To determine predictors of new activities of daily living (ADLs) disability and worsened mobility disability and secondarily increased daily care hours received, in previously independent hip fracture patients. DESIGN:Retrospective cohort study. SETTING:Academic hospital with ambulatory follow-up. PARTICIPANTS:Community-dwelling adults 65?years or older independent in ADLs undergoing hip fracture surgery in 2015 (n?=?184). MEASUREMENTS:Baseline, 3- and 6-month ADLs, mobility, and daily care hours received were ascertained by telephone survey and chart review. Comorbidities, medications, and characteristics of hospitalization were extracted from patient charts. Models for each outcome used logistic regression with a backward elimination strategy, adjusting a priori for age, sex, and race. RESULTS:Predictors of new ADL disability at 3?months were dementia (odds ratio [OR]?=?11.81; P?=?.001) and in-hospital delirium (OR?=?4.20; P?=?.002), and at 6 months were age (OR?=?1.04; P?=?.014), dementia (OR?=?9.91; P?=?.001), in-hospital delirium (OR?=?3.00; P?=?.031) and preadmission opiates (OR?=?7.72; P?=?.003). Predictors of worsened mobility at 3 months were in-hospital delirium (OR?=?4.48; P?=?.001) and number of medications (OR?=?1.13; P?=?.003), and at 6 months were age (OR?=?1.06; P?=?.001), preadmission opiates (OR?=?7.23; P?=?.005), in-hospital delirium (OR?=?3.10; P?=?.019), and number of medications (OR = 1.13; P?=?.013). Predictors of increased daily care hours received at 3 and 6 months were age (3 months: OR?= 1.07; P?=?.014; 6 months: OR?=?1.06; P?=?.017) and number of medications (3 months: OR?=?1.13; P?=?.004; 6 months: OR?=?1.22; P?=?.013). The proportion of patients with ADL disability and care hours received did not change from 3 to 6 months, yet there were significant improvements in mobility. CONCLUSION:Age, dementia, in-hospital delirium, number of medications, and preadmission opiate use were predictors of poor outcomes in independent older adults following hip fracture. Further investigation is needed to identify factors associated with improved mobility measures from 3 to 6 months to ultimately optimize recovery.

Project description:IntroductionCommunity-dwelling people recovering from hip fracture have the physical capacity to walk in their community but lack the confidence to do so. The primary aim of this trial is to determine whether motivational interviewing increases time spent walking at 12 months in community-dwelling people after hip fracture compared with an attention placebo control group. Secondary aims are to evaluate cost effectiveness, patient and health service outcomes and to complete a process evaluation.Methods and analysisAn assessor-blinded parallel group randomised controlled design with embedded health economic evaluation and process evaluation will compare the effects of n=270 participants randomly allocated to an experimental group (motivational interviewing) or a control group (dietary advice). For inclusion, participants are aged ≥65 years, living at home independently within 6 months of discharge from hospital after hip fracture and able to walk independently and communicate with conversational English. Key exclusion criteria are severe depression or anxiety, impaired intellectual functioning and being medically unstable to walk. Participants allocated to the experimental group will receive 10 (8 weekly and 2 booster) telephone-based sessions of motivational interviewing to increase walking over 16 weeks. Participants allocated to the control group will receive an equivalent dose of telephone-based dietary advice. The primary outcome is daily time spent walking over 7 days assessed at weeks 0, 9, 26 and 52. Secondary outcomes include measures of psychological-related function, mobility-related function, community participation, health-related quality of life and falls. Health service utilisation and associated costs will be assessed. Process evaluation will assess the fidelity of the motivational interviewing intervention and explore contextual factors through semistructured interviews.Ethics and disseminationEthical approval obtained from Eastern Health (E19-002), Peninsula Health (50261/EH-2019), Alfred Health (617/20) and La Trobe University (E19/002/50261). The findings will be disseminated in peer-reviewed journals, conference presentations and public seminars.Trial registration numberACTRN12619000936123.

Dataset Information

Opioid Use After Hospital Care due to Hip Fracture Among Community-Dwelling Persons With and Without Alzheimer's Disease.

Publications

Opioid Use After Hospital Care due to Hip Fracture Among Community-Dwelling Persons With and Without Alzheimer's Disease.

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