Sujith Ramachandran, Shishir Maharjan, Liang-Yuan Lin, John P Bentley, Gerald McGwin, Ike Eriator, Kaustuv Bhattacharya, Yi Yang
{"title":"老年医疗保险中阿片类药物剂量逐渐减少的发生率。","authors":"Sujith Ramachandran, Shishir Maharjan, Liang-Yuan Lin, John P Bentley, Gerald McGwin, Ike Eriator, Kaustuv Bhattacharya, Yi Yang","doi":"10.1093/geroni/igaf028","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>Long-term opioid therapy (LTOT) is frequently used for management of chronic noncancer pain, but its associations with increased risks of overdose and mortality have necessitated an evaluation of strategies for tapering or discontinuation. The process of opioid tapering is complex due to associated withdrawal symptoms and potential adverse outcomes. Thus, understanding tapering patterns and associated factors is vital for optimizing pain management, especially for vulnerable older adults.</p><p><strong>Research design and methods: </strong>This cohort study used the 5% national sample of Medicare administrative claims data from 2012 to 2019. The study cohort consisted of individuals aged 65 and older on LTOT. The key outcomes were time until any tapering or rapid tapering of opioids. Various predictor variables, including sociodemographic and clinical factors, were examined. Survival curves were plotted, and Cox proportional hazards models were used for data analysis.</p><p><strong>Results: </strong>The study cohort included 146,605 Medicare beneficiaries on LTOT, of which the largest percentages were aged 65-74 years (48.5%), women (68.0%), and non-Hispanic White (82.3%). Within the first year of LTOT use, nearly 1 in 2 individuals experienced any tapering, and about 1 in 4 individuals experienced rapid tapering. Presence of multiple chronic noncancer pain conditions, hepatic impairment, sleep disorders, higher baseline opioid dose, and LTOT initiation after 2016 were associated with increased rate of both any tapering and rapid tapering. The release of the 2016 CDC guideline was associated with a 45% and 64% increase in the hazards of any tapering and rapid tapering, respectively.</p><p><strong>Discussion and implications: </strong>This study estimated the incidence rate and predictors of opioid tapering among older adults in the United States. Combined with rates of opioid prescribing and prevalence of chronic pain, these epidemiological data are crucial for identifying and improving the safety and effectiveness of pain management among older adults.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"9 6","pages":"igaf028"},"PeriodicalIF":4.9000,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188434/pdf/","citationCount":"0","resultStr":"{\"title\":\"Incidence of Opioid Dose Tapering Among Older Adults Enrolled in Medicare.\",\"authors\":\"Sujith Ramachandran, Shishir Maharjan, Liang-Yuan Lin, John P Bentley, Gerald McGwin, Ike Eriator, Kaustuv Bhattacharya, Yi Yang\",\"doi\":\"10.1093/geroni/igaf028\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and objectives: </strong>Long-term opioid therapy (LTOT) is frequently used for management of chronic noncancer pain, but its associations with increased risks of overdose and mortality have necessitated an evaluation of strategies for tapering or discontinuation. The process of opioid tapering is complex due to associated withdrawal symptoms and potential adverse outcomes. Thus, understanding tapering patterns and associated factors is vital for optimizing pain management, especially for vulnerable older adults.</p><p><strong>Research design and methods: </strong>This cohort study used the 5% national sample of Medicare administrative claims data from 2012 to 2019. The study cohort consisted of individuals aged 65 and older on LTOT. The key outcomes were time until any tapering or rapid tapering of opioids. Various predictor variables, including sociodemographic and clinical factors, were examined. Survival curves were plotted, and Cox proportional hazards models were used for data analysis.</p><p><strong>Results: </strong>The study cohort included 146,605 Medicare beneficiaries on LTOT, of which the largest percentages were aged 65-74 years (48.5%), women (68.0%), and non-Hispanic White (82.3%). Within the first year of LTOT use, nearly 1 in 2 individuals experienced any tapering, and about 1 in 4 individuals experienced rapid tapering. Presence of multiple chronic noncancer pain conditions, hepatic impairment, sleep disorders, higher baseline opioid dose, and LTOT initiation after 2016 were associated with increased rate of both any tapering and rapid tapering. The release of the 2016 CDC guideline was associated with a 45% and 64% increase in the hazards of any tapering and rapid tapering, respectively.</p><p><strong>Discussion and implications: </strong>This study estimated the incidence rate and predictors of opioid tapering among older adults in the United States. Combined with rates of opioid prescribing and prevalence of chronic pain, these epidemiological data are crucial for identifying and improving the safety and effectiveness of pain management among older adults.</p>\",\"PeriodicalId\":13596,\"journal\":{\"name\":\"Innovation in Aging\",\"volume\":\"9 6\",\"pages\":\"igaf028\"},\"PeriodicalIF\":4.9000,\"publicationDate\":\"2025-03-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188434/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Innovation in Aging\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/geroni/igaf028\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"GERIATRICS & GERONTOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Innovation in Aging","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/geroni/igaf028","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"GERIATRICS & GERONTOLOGY","Score":null,"Total":0}
Incidence of Opioid Dose Tapering Among Older Adults Enrolled in Medicare.
Background and objectives: Long-term opioid therapy (LTOT) is frequently used for management of chronic noncancer pain, but its associations with increased risks of overdose and mortality have necessitated an evaluation of strategies for tapering or discontinuation. The process of opioid tapering is complex due to associated withdrawal symptoms and potential adverse outcomes. Thus, understanding tapering patterns and associated factors is vital for optimizing pain management, especially for vulnerable older adults.
Research design and methods: This cohort study used the 5% national sample of Medicare administrative claims data from 2012 to 2019. The study cohort consisted of individuals aged 65 and older on LTOT. The key outcomes were time until any tapering or rapid tapering of opioids. Various predictor variables, including sociodemographic and clinical factors, were examined. Survival curves were plotted, and Cox proportional hazards models were used for data analysis.
Results: The study cohort included 146,605 Medicare beneficiaries on LTOT, of which the largest percentages were aged 65-74 years (48.5%), women (68.0%), and non-Hispanic White (82.3%). Within the first year of LTOT use, nearly 1 in 2 individuals experienced any tapering, and about 1 in 4 individuals experienced rapid tapering. Presence of multiple chronic noncancer pain conditions, hepatic impairment, sleep disorders, higher baseline opioid dose, and LTOT initiation after 2016 were associated with increased rate of both any tapering and rapid tapering. The release of the 2016 CDC guideline was associated with a 45% and 64% increase in the hazards of any tapering and rapid tapering, respectively.
Discussion and implications: This study estimated the incidence rate and predictors of opioid tapering among older adults in the United States. Combined with rates of opioid prescribing and prevalence of chronic pain, these epidemiological data are crucial for identifying and improving the safety and effectiveness of pain management among older adults.
期刊介绍：
Innovation in Aging, an interdisciplinary Open Access journal of the Gerontological Society of America (GSA), is dedicated to publishing innovative, conceptually robust, and methodologically rigorous research focused on aging and the life course. The journal aims to present studies with the potential to significantly enhance the health, functionality, and overall well-being of older adults by translating scientific insights into practical applications. Research published in the journal spans a variety of settings, including community, clinical, and laboratory contexts, with a clear emphasis on issues that are directly pertinent to aging and the dynamics of life over time. The content of the journal mirrors the diverse research interests of GSA members and encompasses a range of study types. These include the validation of new conceptual or theoretical models, assessments of factors impacting the health and well-being of older adults, evaluations of interventions and policies, the implementation of groundbreaking research methodologies, interdisciplinary research that adapts concepts and methods from other fields to aging studies, and the use of modeling and simulations to understand factors and processes influencing aging outcomes. The journal welcomes contributions from scholars across various disciplines, such as technology, engineering, architecture, economics, business, law, political science, public policy, education, public health, social and psychological sciences, biomedical and health sciences, and the humanities and arts, reflecting a holistic approach to advancing knowledge in gerontology.
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