Potentially Inappropriate Medication Prescriptions for Older Adults with Painful Conditions and Association with Return Emergency Department Visits

Steve B. Chukwulebe, Howard Kim, Danielle Molloy McCarthy, D Mark Courtney, Patrick McCafferty Lank, Stephanie J. Gravenor, Scott Michael Dresden*

*Corresponding author for this work

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives: To describe the frequency and risk of return visit to the emergency department (ED) by older adults after prescription of any of four potentially inappropriate medication (PIM) classes included in the 2015 Beers Criteria commonly used for the relief of acute pain in the ED. Design: Retrospective cohort study. Setting: Large urban academic ED from January 1, 2013, to December 31, 2015. Participants: Patients age 65 and older discharged from the ED with an initial pain score of 1 or higher (11 822 visits). Measurements: Prescriptions for PIM classes were collected from the medical record: nonsteroidal anti-inflammatory drugs (NSAIDs), benzodiazepines, skeletal muscle relaxants, and opioids. The proportion of patients with ED returns within 9 days were compared by medication class and pain severity (mild, moderate, or severe). Multivariable logistic regression was performed for each pain category to determine adjusted odds ratios (aORs) of ED return. Results: Of 11 822 included patients, PIMs were prescribed in 3392 (28.7%): 2550 (21.6%) opioids, 826 (7.0%) NSAIDs, 277 (2.3%) benzodiazepines, and 68 (0.6%) nonbenzodiazepine skeletal muscle relaxants. Total 9-day ED returns were 1125 (9.5%): mild 7.0%, moderate 8.3%, and severe pain 11.7%. Opioids were not associated with more frequent ED returns for mild or moderate pain, and they were associated with less frequent ED returns for severe pain (9.2% vs 12.7%; p <.001; aOR 0.69; 95% confidence interval [CI] = 0.54-0.87). Benzodiazepines were associated with more frequent ED returns for patients with moderate pain (15.5% vs 8.2%; p <.01; aOR = 2.01; 95%CI = 1.10-3.70). Conclusions: These results are consistent with recommendations to limit benzodiazepine prescriptions for older adults and that among older adults with severe pain, opioid prescribing is associated with less frequent ED visits within 9 days of discharge. However, this study was not designed to evaluate safety, adverse events, or other important patient-centered outcomes. J Am Geriatr Soc 67:719–725, 2019.

Original languageEnglish (US)
Pages (from-to)719-725
Number of pages7
JournalJournal of the American Geriatrics Society
Volume67
Issue number4
DOIs
StatePublished - Apr 1 2019

Fingerprint

Inappropriate Prescribing
Hospital Emergency Service
Pain
Benzodiazepines
Opioid Analgesics
Neuromuscular Agents
Prescriptions
Potentially Inappropriate Medication List
Anti-Inflammatory Agents
Confidence Intervals
Acute Pain
Pharmaceutical Preparations
Medical Records
Cohort Studies

Keywords

  • benzodiazepines
  • emergency department
  • opioid analgesics
  • pain
  • potentially inappropriate medications

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

@article{b54a5c2c9ba7462ab8096e133239bf5c,
title = "Potentially Inappropriate Medication Prescriptions for Older Adults with Painful Conditions and Association with Return Emergency Department Visits",
abstract = "Objectives: To describe the frequency and risk of return visit to the emergency department (ED) by older adults after prescription of any of four potentially inappropriate medication (PIM) classes included in the 2015 Beers Criteria commonly used for the relief of acute pain in the ED. Design: Retrospective cohort study. Setting: Large urban academic ED from January 1, 2013, to December 31, 2015. Participants: Patients age 65 and older discharged from the ED with an initial pain score of 1 or higher (11 822 visits). Measurements: Prescriptions for PIM classes were collected from the medical record: nonsteroidal anti-inflammatory drugs (NSAIDs), benzodiazepines, skeletal muscle relaxants, and opioids. The proportion of patients with ED returns within 9 days were compared by medication class and pain severity (mild, moderate, or severe). Multivariable logistic regression was performed for each pain category to determine adjusted odds ratios (aORs) of ED return. Results: Of 11 822 included patients, PIMs were prescribed in 3392 (28.7{\%}): 2550 (21.6{\%}) opioids, 826 (7.0{\%}) NSAIDs, 277 (2.3{\%}) benzodiazepines, and 68 (0.6{\%}) nonbenzodiazepine skeletal muscle relaxants. Total 9-day ED returns were 1125 (9.5{\%}): mild 7.0{\%}, moderate 8.3{\%}, and severe pain 11.7{\%}. Opioids were not associated with more frequent ED returns for mild or moderate pain, and they were associated with less frequent ED returns for severe pain (9.2{\%} vs 12.7{\%}; p <.001; aOR 0.69; 95{\%} confidence interval [CI] = 0.54-0.87). Benzodiazepines were associated with more frequent ED returns for patients with moderate pain (15.5{\%} vs 8.2{\%}; p <.01; aOR = 2.01; 95{\%}CI = 1.10-3.70). Conclusions: These results are consistent with recommendations to limit benzodiazepine prescriptions for older adults and that among older adults with severe pain, opioid prescribing is associated with less frequent ED visits within 9 days of discharge. However, this study was not designed to evaluate safety, adverse events, or other important patient-centered outcomes. J Am Geriatr Soc 67:719–725, 2019.",
keywords = "benzodiazepines, emergency department, opioid analgesics, pain, potentially inappropriate medications",
author = "Chukwulebe, {Steve B.} and Howard Kim and McCarthy, {Danielle Molloy} and Courtney, {D Mark} and Lank, {Patrick McCafferty} and Gravenor, {Stephanie J.} and Dresden, {Scott Michael}",
year = "2019",
month = "4",
day = "1",
doi = "10.1111/jgs.15722",
language = "English (US)",
volume = "67",
pages = "719--725",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",
number = "4",

}

TY - JOUR

T1 - Potentially Inappropriate Medication Prescriptions for Older Adults with Painful Conditions and Association with Return Emergency Department Visits

AU - Chukwulebe, Steve B.

AU - Kim, Howard

AU - McCarthy, Danielle Molloy

AU - Courtney, D Mark

AU - Lank, Patrick McCafferty

AU - Gravenor, Stephanie J.

AU - Dresden, Scott Michael

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Objectives: To describe the frequency and risk of return visit to the emergency department (ED) by older adults after prescription of any of four potentially inappropriate medication (PIM) classes included in the 2015 Beers Criteria commonly used for the relief of acute pain in the ED. Design: Retrospective cohort study. Setting: Large urban academic ED from January 1, 2013, to December 31, 2015. Participants: Patients age 65 and older discharged from the ED with an initial pain score of 1 or higher (11 822 visits). Measurements: Prescriptions for PIM classes were collected from the medical record: nonsteroidal anti-inflammatory drugs (NSAIDs), benzodiazepines, skeletal muscle relaxants, and opioids. The proportion of patients with ED returns within 9 days were compared by medication class and pain severity (mild, moderate, or severe). Multivariable logistic regression was performed for each pain category to determine adjusted odds ratios (aORs) of ED return. Results: Of 11 822 included patients, PIMs were prescribed in 3392 (28.7%): 2550 (21.6%) opioids, 826 (7.0%) NSAIDs, 277 (2.3%) benzodiazepines, and 68 (0.6%) nonbenzodiazepine skeletal muscle relaxants. Total 9-day ED returns were 1125 (9.5%): mild 7.0%, moderate 8.3%, and severe pain 11.7%. Opioids were not associated with more frequent ED returns for mild or moderate pain, and they were associated with less frequent ED returns for severe pain (9.2% vs 12.7%; p <.001; aOR 0.69; 95% confidence interval [CI] = 0.54-0.87). Benzodiazepines were associated with more frequent ED returns for patients with moderate pain (15.5% vs 8.2%; p <.01; aOR = 2.01; 95%CI = 1.10-3.70). Conclusions: These results are consistent with recommendations to limit benzodiazepine prescriptions for older adults and that among older adults with severe pain, opioid prescribing is associated with less frequent ED visits within 9 days of discharge. However, this study was not designed to evaluate safety, adverse events, or other important patient-centered outcomes. J Am Geriatr Soc 67:719–725, 2019.

AB - Objectives: To describe the frequency and risk of return visit to the emergency department (ED) by older adults after prescription of any of four potentially inappropriate medication (PIM) classes included in the 2015 Beers Criteria commonly used for the relief of acute pain in the ED. Design: Retrospective cohort study. Setting: Large urban academic ED from January 1, 2013, to December 31, 2015. Participants: Patients age 65 and older discharged from the ED with an initial pain score of 1 or higher (11 822 visits). Measurements: Prescriptions for PIM classes were collected from the medical record: nonsteroidal anti-inflammatory drugs (NSAIDs), benzodiazepines, skeletal muscle relaxants, and opioids. The proportion of patients with ED returns within 9 days were compared by medication class and pain severity (mild, moderate, or severe). Multivariable logistic regression was performed for each pain category to determine adjusted odds ratios (aORs) of ED return. Results: Of 11 822 included patients, PIMs were prescribed in 3392 (28.7%): 2550 (21.6%) opioids, 826 (7.0%) NSAIDs, 277 (2.3%) benzodiazepines, and 68 (0.6%) nonbenzodiazepine skeletal muscle relaxants. Total 9-day ED returns were 1125 (9.5%): mild 7.0%, moderate 8.3%, and severe pain 11.7%. Opioids were not associated with more frequent ED returns for mild or moderate pain, and they were associated with less frequent ED returns for severe pain (9.2% vs 12.7%; p <.001; aOR 0.69; 95% confidence interval [CI] = 0.54-0.87). Benzodiazepines were associated with more frequent ED returns for patients with moderate pain (15.5% vs 8.2%; p <.01; aOR = 2.01; 95%CI = 1.10-3.70). Conclusions: These results are consistent with recommendations to limit benzodiazepine prescriptions for older adults and that among older adults with severe pain, opioid prescribing is associated with less frequent ED visits within 9 days of discharge. However, this study was not designed to evaluate safety, adverse events, or other important patient-centered outcomes. J Am Geriatr Soc 67:719–725, 2019.

KW - benzodiazepines

KW - emergency department

KW - opioid analgesics

KW - pain

KW - potentially inappropriate medications

UR - http://www.scopus.com/inward/record.url?scp=85060766437&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85060766437&partnerID=8YFLogxK

U2 - 10.1111/jgs.15722

DO - 10.1111/jgs.15722

M3 - Article

VL - 67

SP - 719

EP - 725

JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

SN - 0002-8614

IS - 4

ER -