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Prevalence and Factors Associated with Analgesic Prescribing in Poly-Medicated Elderly Patients

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Abstract

Background

Pain is common in older patients and management guidelines rarely consider the effect of multiple comorbidities and concurrent medications on analgesic selection.

Objectives

The objectives of this study were to identify the prevalence and pattern of analgesic prescribing and associated factors in older patients with polypharmacy.

Methods

Older patients (aged ≥ 75 years) admitted to the Royal Adelaide Hospital between September 2015 and August 2016 and with polypharmacy were included and their comorbidities and medications prescribed at discharge were recorded. Drug Burden Index and Charlson Comorbidity Index were calculated. The number of medications that increased the risk of orthostatic hypotension were recorded. Logistic regression was used to compute the association between analgesic use and participant characteristics, and results were presented as odds ratios and 95% confidence intervals, adjusted for age, sex, Charlson Comorbidity Index, Drug Burden Index and orthostatic hypotension.

Results

Over 15,000 admissions were identified, of which 1192 patients were included, 824 (69%) of whom were prescribed an analgesic medication. Paracetamol (used by 89% of analgesic users), opioids (34%) and adjuvants (17%) were used more frequently than non-steroidal anti-inflammatory drugs (8%). Analgesic users had a higher Drug Burden Index, were prescribed more medications and were less likely to be male compared with non-users. Charlson Comorbidity Index across the cohort was high (7.3 ± 1.9) but there was no difference between analgesic users and non-users, but analgesic users were more likely to have a documented diagnosis of osteoarthritis, osteoporosis and falls. Opioid use was associated with the Drug Burden Index, while adjuvant use was associated with orthostatic hypotension. Opioid use was associated with having a diagnosis of osteoporosis and falls.

Conclusions

In our cohort of poly-medicated elderly patients, prescription of analgesic medications was common, and these patients are likely to have an increased rate of adverse drug reactions and falls compared with those who were not prescribed analgesic medications.

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Acknowledgements

The authors thank the medical records officers at the Royal Adelaide Hospital for their endless support and help while reviewing and collecting patient data.

Author information

Authors and Affiliations

  1. School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia

    Aymen Ali Al-Qurain, Lemlem G. Gebremichael, Muhammad Suleman Khan, Desmond B. Williams, Lorraine Mackenzie, Michael S. Roberts & Michael D. Wiese

  2. Basil Hetzel Institute for Translational Research, The Queen Elizabeth Hospital, Woodville, Australia

    Aymen Ali Al-Qurain, Lemlem G. Gebremichael, Muhammad Suleman Khan, Lorraine Mackenzie & Michael S. Roberts

  3. Saudi Arabian Cultural Mission, Ministry of Education, Riyadh, Saudi Arabia

    Aymen Ali Al-Qurain

  4. School of Nursing and Midwifery, University of South Australia, Adelaide, Australia

    Craig Phillips

  5. Royal Adelaide Hospital, Adelaide, Australia

    Patrick Russell

  6. Therapeutics Research Centre, Diamantina Institute, Translational Research Institute, The University of Queensland, Brisbane, Australia

    Michael S. Roberts

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  1. Aymen Ali Al-Qurain
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  2. Lemlem G. Gebremichael
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  3. Muhammad Suleman Khan
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Corresponding author

Correspondence to Michael D. Wiese.

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Funding

No sources of funding were used for the conduct of this study or the preparation of this article.

Conflict of interest

Aymen Ali Al-Qurain, Lemlem G. Gebremichael, Muhammad Suleman Khan, Desmond B. Williams, Lorraine Mackenzie, Craig Phillips, Patrick Russell, Michael S. Roberts and Michael D. Wiese have no conflicts of interest that are directly relevant to the content of this study.

Ethics approval

The study was approved by the Central Adelaide Local Health Network Human Research Ethics Committee and the University of South Australia Human Ethics Committee.

Consent to participate

All participants were de-identified or anonymous.

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Al-Qurain, A.A., Gebremichael, L.G., Khan, M.S. et al. Prevalence and Factors Associated with Analgesic Prescribing in Poly-Medicated Elderly Patients. Drugs Aging 37, 291–300 (2020). https://doi.org/10.1007/s40266-019-00742-0

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  • DOI: https://doi.org/10.1007/s40266-019-00742-0

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