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Risk of Mortality Associated with Potentially Inappropriate Medication Use Including Opioids in Older Adults

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Abstract

Introduction and Objective

As the population ages, understanding the potential risks associated with inappropriate medication use becomes increasingly important. Given the lack of studies in this area, our objective was to study the risk of mortality associated with potentially inappropriate medication use involving opioids in community-dwelling older adults.

Methods

Data came from a longitudinal study on older adults aged ≥ 65 years recruited in primary care clinics between 2011 and 2013 with an average follow-up of 4.25 years. Older adults were excluded if they used an opioid or had a malignant tumor diagnosis in the year before the study survey. A nested case-control within a cohort of older adults with at least one opioid claim during follow-up was used to evaluate the risk of all-cause mortality. Four controls per case were matched on follow-up time using risk-set sampling, i.e., while still at risk of death when their matched case died. The risk of mortality was estimated using conditional logistic regression analyses. Exposure to potentially inappropriate medication use involving opioids, defined using the Beers 2019 criteria, was assessed from provincial drug claims data in the 0–90 days before death.

Results

In a cohort of 472 community-dwelling older adults with an incident episode of opioid use, there were 40 cases matched to 160 controls. Exposure to inappropriate medication use involving opioids in the 90 days before death was associated with an increased risk of mortality (odds ratio 6.81, 95% confidence interval 1.69–27.47), after adjusting for potential confounders.

Conclusions

Exposure to inappropriate medication use involving opioids in the 90 days before death is associated with an increased risk of mortality in older adults. These findings can be used to encourage safer pain management strategies in older adults.

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Authors and Affiliations

  1. Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, QC, J4K 0A8, Canada

    Carina D’Aiuto, Djamal Berbiche, Karine Bertrand & Helen-Maria Vasiliadis

  2. Charles-Le Moyne Research Center (CR-CLM), Longueuil, QC, Canada

    Carina D’Aiuto, Djamal Berbiche, Karine Bertrand & Helen-Maria Vasiliadis

  3. Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy

    Carlotta Lunghi

  4. Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Québec City, QC, Canada

    Line Guénette

  5. Faculty of Pharmacy, Laval University, Québec City, QC, Canada

    Line Guénette

Authors
  1. Carina D’Aiuto
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  2. Carlotta Lunghi
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  4. Djamal Berbiche
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  6. Helen-Maria Vasiliadis
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Corresponding author

Correspondence to Helen-Maria Vasiliadis.

Ethics declarations

Funding

This secondary analysis was funded by Health Canada and the Ministry of Health and Social Services (MSSS). The views expressed do not necessarily reflect those of Health Canada or the MSSS. The funding sources were not involved in the study design, collection, and analysis; data interpretation; report writing; and decision to submit the article for publication.

Conflict of interest

Carina D’Aiuto reports personal fees from Dialogue Health Technologies during the conduct of the study, and has received a doctoral scholarship from the Faculty of Medicine and Health Sciences (FMSS) at the University of Sherbrooke and from the Charles-Le Moyne Research Center (CR-CLM). Carlotta Lunghi, Line Guénette, Djamal Berbiche, Karine Bertrand, and Helen-Maria Vasiliadis have no conflicts of interest to disclose.

Availability of data and material

The datasets generated and/or analyzed during the current study are not publicly available due to privacy and ethical restrictions related to the use of provincial health administrative data. Participants were not asked to give their informed consent for data sharing. The authors are therefore not legally authorized to share or publicly publish linked provincial health and administrative medical record data. The province of Quebec's Commission d'Accès à l'Information (CAI) gave approval to merge these datasets.

Ethics approval

Ethics approval was obtained from the CIUSSS of Estrie-Centre Hospitalier de Sherbrooke (CHUS) [project #2021-3807] to perform secondary analyses on potentially inappropriate use of medications involving opioids using administrative data coupled with data from the ESA Service study. The study was conducted in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Consent to participate

Written informed consent was obtained from all individuals prior to study entry.

Consent for publication

Not applicable.

Code availability

Not applicable.

Author contributions

Carina D’Aiuto analyzed the data and wrote the first draft of the manuscript. Helen-Maria Vasiliadis, Carlotta Lunghi, Line Guénette, and Karine Bertrand contributed to the study conception/design and obtained funding. Djamal Berbiche prepared the database and study variables. All authors commented on previous versions of the manuscript and have read and approved the final version of the manuscript.

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D’Aiuto, C., Lunghi, C., Guénette, L. et al. Risk of Mortality Associated with Potentially Inappropriate Medication Use Including Opioids in Older Adults. Drug Saf (2024). https://doi.org/10.1007/s40264-024-01429-1

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