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Analgesic Use and Frailty among Community-Dwelling Older People

A Population-Based Study

  • Original Research Article
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Abstract

Background

Frail older people have a decreased ability to respond to stressors and may therefore be more susceptible to adverse events related to inadequately treated pain. Conversely, aging- and frailty-related changes in pharmacokinetics and pharmacodynamics may predispose frail older people to adverse events of analgesics.

Objective

The aim of this study was to explore whether analgesic use is associated with frailty status and whether there are differences in the types of analgesics used between frailty groups among community-dwelling older people.

Methods

The study population consisted of 605 community-dwelling people aged >75 years. Demographic, diagnostic and drug use data were collected during standardized nurse interviews. Participants were classified as frail, pre-frail or robust using the Cardiovascular Health Study frailty criteria (weight loss, weakness, exhaustion, slowness and low physical activity).

Results

Overall, 11.4 % (n = 69) of the study participants were frail and 49.4 % (n = 299) were pre-frail. The prevalence of prescription and non-prescription analgesic use was higher among frail (68.1 %) than among pre-frail (54.5 %) and robust (40.5 %) older people (p < 0.001). In multivariate analyses, frailty was positively associated with analgesic use (odds ratio 2.96; 95 % CI 1.38–6.36). However, frail analgesic users (46.7 %) were more likely to want their physicians to pay greater attention to pain management than robust (23.2 %) analgesic users. The most prevalent analgesic was acetaminophen (paracetamol) among frail (78.7 %) and pre-frail (63.2 %), and NSAIDs among robust (60.4 %) analgesic users. Frail (60.3 %) and pre-frail (58.1 %) participants were more likely to report musculoskeletal pain than robust (44.7 %) participants. Of robust, pre-frail and frail older people 33.0 %, 23.1 % and 4.9 % (respectively) did not use any analgesics to treat their pain.

Conclusions

Frailty was associated with a higher prevalence of analgesic use. As frail older people may be more susceptible to adverse events, careful selection of analgesics is warranted. Clinicians should pay more attention to pain management to ensure adequate pain relief.

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References

  1. Thomas E, Peat G, Harris L, et al. The prevalence of pain and pain interference in a general population of older adults: cross-sectional findings from the North Staffordshire Osteoarthritis Project (NorStOP). Pain. 2004;110(1–2):361–8.

    Article  PubMed  Google Scholar 

  2. Sawyer P, Bodner EV, Ritchie CS, et al. Pain and pain medication use in community-dwelling older adults. Am J Geriatr Pharmacother. 2006;4(4):316–24.

    Article  PubMed  Google Scholar 

  3. Soldato M, Liperoti R, Landi F, et al. Non malignant daily pain and risk of disability among older adults in home care in Europe. Pain. 2007;129(3):304–10.

    Article  PubMed  Google Scholar 

  4. Maxwell CJ, Dalby DM, Slater M, et al. The prevalence and management of current daily pain among older home care clients. Pain. 2008;138(1):208–16.

    Article  PubMed  Google Scholar 

  5. Blyth FM, Rochat S, Cumming RG, et al. Pain, frailty and comorbidity on older men: the CHAMP study. Pain. 2008;140(1):224–30.

    Article  PubMed  Google Scholar 

  6. Weaver GD, Kuo YF, Raji MA, et al. Pain and disability in older Mexican–American adults. J Am Geriatr Soc. 2009;57(6):992–9.

    Article  PubMed  Google Scholar 

  7. Chen CY, Wu SC, Chen LJ, et al. The prevalence of subjective frailty and factors associated with frailty in Taiwan. Arch Gerontol Geriatr. 2010;50(Suppl. 1):S43–7.

    Article  PubMed  Google Scholar 

  8. Shega JW, Dale W, Andrew M, et al. Persistent pain and frailty: a case for homeostenosis. J Am Geriatr Soc. 2012;60(1):113–7.

    Article  PubMed  Google Scholar 

  9. Arola HM, Nicholls E, Mallen C, et al. Self-reported pain interference and symptoms of anxiety and depression in community-dwelling older adults: can a temporal relationship be determined? Eur J Pain. 2010;14(9):966–71.

    Google Scholar 

  10. Chen Q, Hayman LL, Shmerling RH, et al. Characteristics of chronic pain associated with sleep difficulty in older adults: the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILIZE) Boston study. J Am Geriatr Soc. 2011;59(8):1385–92.

    Article  PubMed  Google Scholar 

  11. Bosley BN, Weiner DK, Rudy TE, et al. Is chronic nonmalignant pain associated with decreased appetite in older adults? Preliminary evidence. J Am Geriatr Soc. 2004;52(2):247–51.

    Article  PubMed  Google Scholar 

  12. Karttunen N, Lihavainen K, Sipila S, et al. Musculoskeletal pain and use of analgesics in relation to mobility limitation among community-dwelling persons aged 75 years and older. Eur J Pain. 2012;16(1):140–9.

    Article  PubMed  CAS  Google Scholar 

  13. Leveille SG, Jones RN, Kiely DK, et al. Chronic musculoskeletal pain and the occurrence of falls in an older population. JAMA. 2009;302(20):2214–21.

    Article  PubMed  CAS  Google Scholar 

  14. Fried LP, Ferrucci L, Darer J, et al. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci. 2004;59(3):255–63.

    Article  PubMed  Google Scholar 

  15. AGS Panel on Persistent Pain in Older Persons. The management of persistent pain in older persons. J Am Geriatr Soc. 2002;50(6 Suppl):S205–24.

    Google Scholar 

  16. McLachlan AJ, Bath S, Naganathan V, et al. Clinical pharmacology of analgesic medicines in older people: impact of frailty and cognitive impairment. Br J Clin Pharmacol. 2011;71(3):351–64.

    Article  PubMed  CAS  Google Scholar 

  17. Barber JB, Gibson SJ. Treatment of chronic non-malignant pain in the elderly: safety considerations. Drug Saf. 2009;32(6):457–74.

    Article  PubMed  CAS  Google Scholar 

  18. Lampela P, Hartikainen S, Lavikainen P, et al. Effects of medication assessment as part of a comprehensive geriatric assessment on drug use over a 1-year period: a population-based intervention study. Drugs Aging. 2010;27(6):507–21.

    Article  PubMed  Google Scholar 

  19. Pokela N, Bell JS, Lihavainen K, et al. Analgesic use among community-dwelling people aged 75 years and older: A population-based interview study. Am J Geriatr Pharmacother. 2010;8(3):233–44.

    Article  PubMed  Google Scholar 

  20. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56.

    Article  PubMed  CAS  Google Scholar 

  21. Woods NF, LaCroix AZ, Gray SL, et al. Frailty: emergence and consequences in women aged 65 and older in the Women’s Health Initiative Observational Study. J Am Geriatr Soc. 2005;53(8):1321–30.

    Article  PubMed  Google Scholar 

  22. Bandeen-Roche K, Xue QL, Ferrucci L, et al. Phenotype of frailty: characterization in the women’s health and aging studies. J Gerontol A Biol Sci Med Sci. 2006;61(3):262–6.

    Article  PubMed  Google Scholar 

  23. Kiely DK, Cupples LA, Lipsitz LA. Validation and comparison of two frailty indexes: The MOBILIZE Boston Study. J Am Geriatr Soc. 2009;57(9):1532–9.

    Article  PubMed  Google Scholar 

  24. Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1983;17(1):37–49.

    Article  CAS  Google Scholar 

  25. Grimby G. Physical activity and muscle training in the elderly. Acta Med Scand Suppl. 1986;711:233–7.

    PubMed  CAS  Google Scholar 

  26. WHO Collaborating Centre for Drug Statistics Methodology. The Anatomical Therapeutic Chemical classification system. Oslo: WHO Collaborating Centre for Drug Statistics Methodology, Norwegian Institute of Public Health; 2012. http://www.whocc.no/atc_ddd_index/. Accessed 27 Mar 2012.

  27. International Association for the Study of Pain Subcommittee on Taxonomy. Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Pain Suppl. 1986;3:S1–226.

    Google Scholar 

  28. Crum RM, Anthony JC, Bassett SS, et al. Population-based norms for the Mini-Mental State Examination by age and educational level. JAMA. 1993;269(18):2386–91.

    Article  PubMed  CAS  Google Scholar 

  29. Groll DL, To T, Bombardier C, et al. The development of a comorbidity index with physical function as the outcome. J Clin Epidemiol. 2005;58(6):595–602.

    Article  PubMed  Google Scholar 

  30. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3):179–86.

    Article  PubMed  CAS  Google Scholar 

  31. Guigoz Y, Lauque S, Vellas BJ. Identifying the elderly at risk for malnutrition. The Mini Nutritional Assessment. Clin Geriatr Med. 2002;18(4):737–57.

    Article  PubMed  Google Scholar 

  32. Landi F, Onder G, Cesari M, et al. Pain management in frail, community-living elderly patients. Arch Intern Med. 2001;161(22):2721–4.

    Article  PubMed  CAS  Google Scholar 

  33. Rochat S, Cumming RG, Blyth F, et al. Frailty and use of health and community services by community-dwelling older men: the Concord Health and Ageing in Men Project. Age Ageing. 2010;39(2):228–33.

    Article  PubMed  Google Scholar 

  34. Hoeck S, François G, Geerts J, et al. Health-care and home-care utilization among frail elderly persons in Belgium. Eur J Public Health. 2012;22(5):671–7.

    Article  PubMed  Google Scholar 

  35. American Geriatrics Society Panel on Pharmacological Management of Persistent Pain in Older Persons. Pharmacological management of persistent pain in older persons. J Am Geriatr Soc. 2009;57(8):1331–46.

    Google Scholar 

Download references

Acknowledgments

The GeMS study was supported by grants from the Social Insurance Institution of Finland and City of Kuopio. The funding sources had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; or preparation, review and approval of the manuscript. All authors declare that they have no financial or other relationships that might lead to a conflict of interest. The authors thank the GeMS study personnel and participants for their dedicated work.

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Authors and Affiliations

  1. Kuopio Research Centre of Geriatric Care, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, P.O. Box. 1627, 70211, Kuopio, Finland

    Marjaana P. H. Koponen, J. Simon Bell, Niina M. Karttunen, Irma A. Nykänen, Franciska A. M. Desplenter & Sirpa A. Hartikainen

  2. Social Pharmacy, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland

    Marjaana P. H. Koponen

  3. Clinical Pharmacology and Geriatric Pharmacotherapy Unit, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland

    J. Simon Bell, Niina M. Karttunen, Irma A. Nykänen, Franciska A. M. Desplenter & Sirpa A. Hartikainen

  4. Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia

    J. Simon Bell

  5. Research Centre for Pharmaceutical Care and Pharmacoeconomics, Faculty of Pharmaceutical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium

    Franciska A. M. Desplenter

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  1. Marjaana P. H. Koponen
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Correspondence to Marjaana P. H. Koponen.

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Koponen, M.P.H., Bell, J.S., Karttunen, N.M. et al. Analgesic Use and Frailty among Community-Dwelling Older People. Drugs Aging 30, 129–136 (2013). https://doi.org/10.1007/s40266-012-0046-8

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