Time Trends in Opioid Use by Dementia Severity in Long-Term Care Nursing Home Residents.
Hemalkumar B Mehta, Yong-Fang Kuo, Mukaila Raji and 3 others
PMID 32605815WHAT IT FOUND
Nursing home residents with moderate or severe dementia were significantly less likely to receive opioids than those with no dementia.
This gap persisted even after adjusting for pain levels. Lower prescribing may reflect under-treatment or alternative strategies, not reduced pain.
Key findings
01Residents with moderate or severe dementia had significantly lower odds of receiving any opioids compared to residents with no dementia.
02The disparity in opioid use persisted in residents who experienced an acute fracture, with those having severe dementia being least likely to receive opioids.
03Pain reporting decreased as dementia severity increased, yet the study controlled for pain level and still found lower opioid use in dementia patients.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study could not determine if lower opioid use was due to under-treatment or successful use of non-opioid alternatives. Pain assessment relied on initial measurements, which may not reflect pain fluctuations over time. The fracture cohort excluded patients who were hospitalized, potentially missing those with the most severe pain or injuries. Prescription data does not confirm if the medication was actually administered to the resident.
Declared interests
All authors reported no conflicts of interest.
The easy way to misread this
Do not interpret the lower opioid use in dementia patients as evidence that their pain is adequately managed by other means. The study shows a prescribing gap, not a treatment outcome, and under-treatment of pain remains a possibility.