Prophylaxis for opioid-induced constipation in elderly long-term care residents: a cross-sectional study of Medicare beneficiaries.
BACKGROUND
Opioid analgesics are effective therapeutic agents for malignant and nonmalignant pain, but their use is often compromised by unwanted adverse effects on the central nervous system and gastrointestinal (GI) tract. These adverse effects include sedation, respiratory depression, nausea and vomiting, reduction in biliary and pancreatic secretions, decreased GI motility, increased GI transit time, and subsequent constipation.


OBJECTIVE
The goal of this study was to determine national estimates of laxative use, with and without concurrent opioids, in the long-term care (LTC) population and to determine factors associated with laxative underuse among elderly LTC residents receiving opioids.


METHODS
This cross-sectional study was conducted in LTC facilities in the United States. Medicare beneficiaries participating in the Medicare Current Beneficiary Survey (MCBS) aged >or=65 years residing at least 1 month in a nursing home or assisted living facility in 2001 were considered eligible. Monthly and annual measures of laxative and opioid use were developed to estimate prevalence of drug use in the LTC population. Multivariable logistic regression was used to determine factors associated with the use of laxatives.


RESULTS
Among our sample of 867 MCBS beneficiaries (mean [SD]age, 85.0 [7.7] years), 281 (32%) received at least 1 opioid at some time during 2001. Of these 281 patients, 186 (66%) were administered at least 1 laxative at any time of the year. We found that the mean monthly prevalence of concurrent opioid and laxative use was 55% (476/867). There was a low prevalence of as-needed laxative and opioid use; 96% of resident-months were identified as scheduled bowel regimen administrations, and 89% of resident-months with opioid use had >or=3 opioid administrations. The results of the multivariable analysis showed that white, female, and currently married patients spend 227% (P < 0.007), 52% (p < 0.008), and 39% (P < 0.02), respectively, more months with at least 1 administration of a laxative and an opioid than their counterpart nonwhite, male, unmarried patients, Comorbidities were not associated with laxative prophylaxis.


CONCLUSIONS
Although laxatives are widely recommended in patients taking opioids, only 66% of elderly LTC residents in this study received this standard of care.
Max
Ellina K
EK
Department of Pharmacy, Brigham & Women's Hospital, Boston, Massachusetts, USA.
Hernandez
Jose J
JJ
Sturpe
Deborah A
DA
Zuckerman
Ilene H
IH
D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects*; D002400:Cathartics / Q000627:therapeutic use*; D003248:Constipation / Q000139:chemically induced* / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D004363:Drug Utilization; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008297:Male; D006278:Medicare; D012959:Socioeconomic Factors; D014481:United States
D000701:Analgesics, Opioid; D002400:Cathartics