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Incident Functional Limitations Among Community-Dwelling Adults Using Opioids: A Retrospective Cohort Study Using a Propensity Analysis with the Health and Retirement Study

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Abstract

Background

Opioid analgesics are commonly used to manage pain; however, it is unclear how they affect patient function. This study examines the association between opioid analgesics and incident limitations in activities of daily living (ADL), instrumental activities of daily living (IADL), and cognitive functioning among community-dwelling older adults.

Methods

Data included 10,003 participants of the 2016 and 2018 waves of the Health and Retirement Study, which sampled US adults aged 51–98 years. The primary exposure was self-reported opioid pain medication use in 2016. Outcomes included incident limitations in ADL, IADL, and cognitive functioning in 2018. Statistical methods adjusted for confounding using multivariable logistic regressions, inverse probability of treatment weighting, and propensity scores.

Results

Opioid use (adjusted odds ratio [aOR]: 1.34, 95% confidence interval [CI] 1.07–1.68) was associated with a statistically significant higher odds of incident ADL limitation in multivariable regression and in propensity score adjustment (aOR: 1.41, 95% CI 1.13–1.76). The association between opioid use and ADL and IADL limitations was modified by age. Adults aged < 65 years had a higher odds of incident ADL (aOR: 1.83, 95% CI 1.38–2.42) and IADL (aOR: 1.42, 95% CI 1.06–1.90) limitations compared with those aged ≥ 65 years.

Conclusions

Community-dwelling adults using opioid analgesics to manage pain may be at risk for incident ADL limitations. Middle-aged adults, compared with those older than 65 years of age, experienced the greatest odds for incident ADL and IADL limitations following opioid use. According to sensitivity analyses, our findings were robust to unmeasured confounding.

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Acknowledgements

We thank Sarah Toombs Smith, PhD, ELS (University of Texas Medical Branch), who aided in proofreading and editing the manuscript. She was not compensated for her contribution beyond her institutional salary.

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Authors and Affiliations

  1. Department of Nutrition, Metabolism, and Rehabilitation Sciences, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555-1137, USA

    Kevin T. Pritchard & Brian Downer

  2. Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA

    Mukaila A. Raji

  3. Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA

    Jacques Baillargeon & Yong-Fang Kuo

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  1. Kevin T. Pritchard
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  5. Yong-Fang Kuo
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Corresponding author

Correspondence to Kevin T. Pritchard.

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Funding

This study was supported with funding from the National Institutes on Drug Abuse R01DA039192, the National Institute on Aging K01AG058789 and P30-AG024832, the Agency for Healthcare Research and Quality T32HS02613301, and the National Center for Complementary and Integrative Health F31AT011856. The funders had no role in the design and conduct of the study, the collection, management, analysis, and interpretation of the data, the preparation, review, or approval of the manuscript, and the decision to submit the manuscript for publication.

Conflict of interest

The authors have no conflicts of interest that are directly relevant to the content of this article.

Ethics approval

The University of Michigan’s Institutional Review Board approved the Health and Retirement Study. No other approval was applicable.

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Not applicable.

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Not applicable.

Availability of data and material

Health and Retirement Study [RAND HRS Longitudinal File]* public use dataset. Produced and distributed by the University of Michigan with funding from the National Institute on Aging (grant number NIA U01AG009740), Ann Arbor, MI, USA (2021).

Code availability

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Author contributions

Concept and design: all authors. Acquisition, analysis, or interpretation of data: all authors. Drafting of the manuscript: all authors. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: BD, Y-FK, and KTP. Obtained funding: BD, Y-FK, MAR, and KTP. Supervision: JB and Y-FK.

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Pritchard, K.T., Downer, B., Raji, M.A. et al. Incident Functional Limitations Among Community-Dwelling Adults Using Opioids: A Retrospective Cohort Study Using a Propensity Analysis with the Health and Retirement Study. Drugs Aging 39, 559–571 (2022). https://doi.org/10.1007/s40266-022-00953-y

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