title: Analgesic use and frailty among community-dwelling older people: a population-based study.
abstract: BACKGROUND
  Frail older people have a decreased ability to respond to stressors and may therefore be more susceptible to adverse events related to inadequately treated pain. Conversely, aging- and frailty-related changes in pharmacokinetics and pharmacodynamics may predispose frail older people to adverse events of analgesics.
  
  
  OBJECTIVE
  The aim of this study was to explore whether analgesic use is associated with frailty status and whether there are differences in the types of analgesics used between frailty groups among community-dwelling older people.
  
  
  METHODS
  The study population consisted of 605 community-dwelling people aged >75 years. Demographic, diagnostic and drug use data were collected during standardized nurse interviews. Participants were classified as frail, pre-frail or robust using the Cardiovascular Health Study frailty criteria (weight loss, weakness, exhaustion, slowness and low physical activity).
  
  
  RESULTS
  Overall, 11.4 % (n = 69) of the study participants were frail and 49.4 % (n = 299) were pre-frail. The prevalence of prescription and non-prescription analgesic use was higher among frail (68.1 %) than among pre-frail (54.5 %) and robust (40.5 %) older people (p < 0.001). In multivariate analyses, frailty was positively associated with analgesic use (odds ratio 2.96; 95 % CI 1.38-6.36). However, frail analgesic users (46.7 %) were more likely to want their physicians to pay greater attention to pain management than robust (23.2 %) analgesic users. The most prevalent analgesic was acetaminophen (paracetamol) among frail (78.7 %) and pre-frail (63.2 %), and NSAIDs among robust (60.4 %) analgesic users. Frail (60.3 %) and pre-frail (58.1 %) participants were more likely to report musculoskeletal pain than robust (44.7 %) participants. Of robust, pre-frail and frail older people 33.0 %, 23.1 % and 4.9 % (respectively) did not use any analgesics to treat their pain.
  
  
  CONCLUSIONS
  Frailty was associated with a higher prevalence of analgesic use. As frail older people may be more susceptible to adverse events, careful selection of analgesics is warranted. Clinicians should pay more attention to pain management to ensure adequate pain relief.
authors.affiliation: Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, 70211 Kuopio, Finland. marjaana.koponen@uef.fi
authors.forename: Marjaana P H
authors.initials: MP
authors.lastname: Koponen
authors.forename: J Simon
authors.initials: JS
authors.lastname: Bell
authors.forename: Niina M
authors.initials: NM
authors.lastname: Karttunen
authors.forename: Irma A
authors.initials: IA
authors.lastname: Nykänen
authors.forename: Franciska A M
authors.initials: FA
authors.lastname: Desplenter
authors.forename: Sirpa A
authors.initials: SA
authors.lastname: Hartikainen
mesh_terms: D000368:Aged; D000700:Analgesics / Q000627:therapeutic use*; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005387:Finland / Q000453:epidemiology; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010146:Pain / Q000188:drug therapy* / Q000453:epidemiology; D010147:Pain Measurement; D012111:Residence Characteristics
chemical_list: D000700:Analgesics