Pain intensity, physical function, and depressive symptoms associated with discontinuing long‐term opioid therapy in older adults with Alzheimer's disease and related dementias

• Published in: Alzheimer's & dementia 2024-02, Vol.20 (2), p.1026-1037
• Main Authors: Wei, Yu‐Jung Jenny, Winterstein, Almut G., Schmidt, Siegfried, Fillingim, Roger B., Daniels, Michael J., Solberg, Laurence, DeKosky, Steven T.
• Format: Article
• Language: English
• Subjects: Activities of daily living; Aged; Alzheimer Disease - complications; Alzheimer Disease - drug therapy; Alzheimer's disease; Alzheimer's disease and related dementias; Analgesics, Opioid - therapeutic use; Beneficiaries; Chronic pain; Chronic Pain - drug therapy; Clinical outcomes; Cohort analysis; Cohort Studies; Dementia; Depression - drug therapy; Discontinued; Humans; long‐term opioid therapy; Medicare; Mental depression; Narcotics; Nursing homes; Older people; Opioids; Pain; Pain management; Pain Measurement; Physical ability; Physical symptoms; Prescription drugs; Retrospective Studies; Substance use disorder; Symptoms; United States
• ISSN: 1552-5260; 1552-5279; 1552-5279
• DOI: 10.1002/alz.13489

INTRODUCTION Limited evidence exists on the associations of discontinuing versus continuing long‐term opioid therapy (LTOT) with pain intensity, physical function, and depression among patients with Alzheimer's disease and related dementias (ADRD). METHODS A cohort study among 138,059 older residents with mild‐to‐moderate ADRD and receipt of LTOT was conducted using a 100% Medicare nursing home sample. Discontinuation of LTOT was defined as no opioid refills for ≥ 60 days. Outcomes were worsening pain, physical function, and depression from baseline to quarterly assessments during 1‐ and 2‐year follow‐ups. RESULTS The adjusted odds of worsening pain and depressive symptoms were 29% and 5% lower at the 1‐year follow‐up and 35% and 9% lower at the 2‐year follow‐up for residents who discontinued versus continued LTOT, with no difference in physical function. DISCUSSION Discontinuing LTOT was associated with lower short‐ and long‐term worsening pain and depressive symptoms than continuing LTOT among older residents with ADRD. Highlights Discontinuing long‐term opioid therapy (LTOT) was associated with lower short‐ and long‐term worsening pain. Discontinuing LTOT was related to lower short‐ and long‐term worsening depression. Discontinuing LTOT was not associated with short‐ and long‐term physical function.