Analgesic use among community-dwelling people aged 75 years and older: A population-based interview study

Abstract

Background: Pain is often underrecognized and undertreated among older people. However, older people may be particularly susceptible to adverse drug reactions linked to prescription and nonprescription analgesics.

Objectives: The aims of this study were to assess the prevalence of analgesic use among a random sample of community-dwelling people aged >or=75 years, and to investigate factors associated with daily and as-needed analgesic use.

Methods: A random sample of people aged >or=75 years was drawn from the population register in Kuopio, Finland, in November 2003. Data on prescription and nonprescription analgesic use were elicited during nurse interviews conducted once for each participant in 2004. Self-reported drug utilization data were verified against medical records. The interview included items pertaining to sociodemographic factors, living conditions, social contacts, health behavior, and state of health. Physical function was assessed using the Instrumental Activities of Daily Living Scale, and the 10-item Barthel Index. Self-rated mobility was assessed by asking whether respondents could walk 400 meters (yes, yes with difficulty but without help, not without help, or no). Cognitive function was assessed using the Mini-Mental State Examination. The presence of depressive symptoms was assessed using the 15-item Geriatric Depression Scale. Respondents' self-rated health was determined using a 5-point scale (very poor, poor, moderate, good, or very good).

Results: Of the initial random sample of participants (N = 1000), 700 provided consent to participate and were community dwelling. Among the participants, 318 (45.4%) were users of >or=1 analgesic on a daily or as-needed basis. Only 23.3% of analgesic users took an analgesic on a daily basis. Factors associated with any analgesic use included female sex (odds ratio [OR], 1.78 [95 degrees % CI, 1.17-2.71]), living alone (OR, 1.46 [95 degrees % CI, 1.02-2.11]), poor self-rated health (OR, 2.6 [95% CI, 1.22-3.84]), and use of >or=10 nonanalgesic drugs (OR, 2.21 [95% CI, 1.26-3.87]). Among users of >or=1 oral analgesic, factors associated with opioid use included moderate (OR, 2.46 [95% CI, 1.175.14]) and poor (OR, 2.57 [95% CI, 1.03-6.42]) self-rated health. Opioid use (OR, 0.19 [95% CI, 0.04-0.86]) and daily analgesic use (OR, 0.16 [95% CI, 0.34-0.74]) were inversely associated with depressive symptoms. Pain in the previous month was reported by 71.4% of analgesic users and 26.4% of nonusers of analgesics.

Conclusions: Analgesics were used by approximately 50% of community-dwelling people aged >or=75 years. However, age was not significantly associated with increased use of analgesics in multivariate analysis. The majority of analgesic drugs were used on an as-needed rather than a daily basis (76.7% vs 23.3%, respectively). Factors most significantly associated with analgesic use were female sex, living alone, poor self-rated health, and use of >or=10 nonanalgesic drugs.