Trends and Guideline Adherence in Gabapentinoid Use among Geriatric Outpatients: A Retrospective Cross-Sectional Study at a Falls Clinic.

Abstract

Purpose: With pain treatment shifting away from opioids, alternative analgesics-such as gabapentinoids-are increasingly being used. This study investigated the prevalence and indications for gabapentinoid use among geriatric outpatients, a population particularly vulnerable to central nervous system (CNS)-active drugs.

Methods: A retrospective cross-sectional chart review was conducted among patients visiting the geriatric falls clinic at Aalborg University Hospital, Denmark, in 2013-14, 2018-19 and 2023. Demographic data, comorbidities, medication status, fall frequency, in-clinic measurements, reported pain and dizziness, frailty status, as well as indications for gabapentinoid prescriptions were extracted and classified according to guidelines.

Results: A total of 773 patients were screened, and 635 included (2013/2018/2023, n = 144/265/226). The mean age was 81.2 years, 59% were female, and nearly half of the patients were frail (Clinical Frailty Scale (CFS) ≥ 5). Chronic pain was increasingly reported at the falls clinic (46/62/68%, p < 0.001). Gabapentinoid use increased with time (3.5/10.9/15%, p = 0.002), while opioid use decreased (29.2/19.2/11.9%, p < 0.001). A total of 65 patients took gabapentinoids for pain, of which 42 (62%) were not supported by guidelines; 18 (26%) were vaguely supported, while only five (7%) were clearly supported by guidelines. Most had been on gabapentinoids for > 1 year, and deprescription was initiated in approximately 40%.

Conclusions: A marked increase in gabapentinoid use among patients assessed at the geriatric falls clinic was found, with a corresponding decrease in opioid use. The majority of gabapentinoid prescriptions were for indications not supported by guidelines.