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Table 5 Weighted proportion of inappropriate opioid prescribing practice for patients with or without ADRD by residential setting

From: Quality of opioid prescribing in older adults with or without Alzheimer disease and related dementia

Quality indicators of inappropriate opioid prescribinga

Community

P-value

Nursing home

P-value

Weighted proportion among patients with ADRD, %

Weighted proportion among patients without ADRD, %

Proportion difference (95% CI)b

Weighted proportion among patients with ADRD, %

Weighted proportion among patients without ADRD, %

Proportion difference (95% CI)b

Use of opioids contraindicated for older adults with chronic pain

 Use of meperidine, propoxyphene or partial or mixed opioid agonsists

0.08

0.12

− 0.04 (− 0.06 to − 0.01)

< .001

0.05

0.21

− 0.2 (− 0.3 to − 0.03)

< .001

Opioid prescribing for opioid-naive patients

 Use of long-acting opioid

0.49

0.62

− 0.13 (− 0.20 to − 0.06)

< .001

1.3

1.8

− 0.5 (− 1.0 to 0.04)

.070

 Use of high-dose opioid

1.3

2.5

− 1.2 (− 1.3 to − 1.1)

< .001

1.9

2.6

− 0.7 (− 1.3 to − 0.05)

.035

 Composite of either

1.5

2.8

− 1.3 (− 1.4 to − 1.1)

< .001

2.5

3.5

− 1.0 (− 1.7 to − 0.2)

.010

Opioid prescribing for patients with neuropathic pain as the index diagnosis

 Long-term use of opioid

21.7

19.5

2.2 (1.3 to 3.1)

.003

26.9

36.0

− 9.2 (− 13.6 to − 4.7)

< .001

Sensitivity analysis: for patients with neuropathic pain without baseline musculoskeletal or idiopathic pain

 Long-term use of opioid

12.1

10.4

1.8 (0.6 to 2.9)

< .001

25.7

33.1

− 7.5 (− 12.1 to − 2.8)

< .001

Concurrent use of opioid and CNS depressant for opioid users

 With any qualifying CNS depressantc

44.1

33.3

10.8 (10.2 to 11.4)

< .001

58.8

54.1

4.7 (2.8 to 6.6)

< .001

 With benzodiazepine

19.5

15.3

4.2 (3.7 to 4.6)

< .001

21.0

23.2

− 2.2 (− 3.8 to − 0.6)

< .001

 With SSRI or TCA

26.8

19.6

7.2 (6.7 to 7.7)

< .001

39.1

38.2

0.96 (− 0.9 to 2.8)

.307

 With antipsychotic

10.4

4.6

5.8 (5.4 to 6.1)

< .001

26.2

11.4

14.8 (13.5 to 16.1)

< .001

 With nonbenzodiazepine

9.5

8.2

1.3 (1.0 to 1.7)

< .001

6.7

9.7

− 3.0 (− 4.1 to − 1.9)

< .001

Opioid or other scheduled analgesic regimen for moderate to severe paind

 No use of prescription opioide

ND

ND

ND

ND

32.7

24.6

8.1 (6.1 to 10.1)

< .001

 No use of scheduled pain medicationf

ND

ND

ND

ND

47.8

43.1

4.7 (2.4 to 7.0)

< .001

 Composite of either

ND

ND

ND

ND

60.1

52.5

7.6 (5.3 to 9.9)

< .001

  1. Abbreviations: ADRD Alzheimer disease and related dementias, CNS central nervous system, MDS 3.0 Minimum Data Set, version 3.0, MME morphine milligram equivalent, ND not determined, SNRI serotonin-norepinephrine reuptake inhibitor, SSRI selective serotonin reuptake inhibitor, TCA tricyclic antidepressant
  2. aMeasured during the 12 months after diagnosis of chronic pain randomly selected per patient
  3. bProportion difference between ADRD and non-ADRD groups was estimated with generalized linear models along with weight statement (to incorporate inverse probability weighting that balances differences in baseline characteristics between the ADRD and non-ADRD groups)
  4. cCNS-active drugs included antipsychotics, benzodiazepine, nonbenzodiazepine or hypnotics, tricyclic antidepressants, and SNRIs
  5. dDefined as having at least 1 quarterly MDS 3.0 pain assessment with a numeric rating scale score of 4 or more, or moderate or severe pain based on a verbal descriptor scale
  6. eMeasured as having at least 1 quarterly MDS 3.0 moderate to severe pain score without prescription opioids dispensed within 30 days before and after the MDS 3.0 pain assessment
  7. fMeasured as having at least 1 quarterly MDS 3.0 moderate to severe pain score that had no scheduled pain medications (assessed in MDS 3.0 Section J)