title: Eight-Year Trends in the Use of Opioids, Other Analgesics, and Psychotropic Medications Among Institutionalized Older People in Finland.
abstract: OBJECTIVE
  It is recognized that pain has been undertreated and psychotropic medications overused in institutional settings.
  
  
  OBJECTIVE
  To investigate the change in prevalence of opioids, other analgesics, and psychotropic medications in institutional settings over an 8-year period.
  
  
  METHODS
  Institutional settings in Helsinki, Finland.
  
  
  METHODS
  Older residents in nursing homes in 2003 (n = 1987) and 2011 (n = 1576) and in assisted living facilities in 2007 (n = 1377) and 2011 (n = 1586).
  
  
  METHODS
  Comparable audits of medication use were conducted among institutionalized residents at 3 time points over 8 years. The prevalence of regular opioid, other analgesic, and psychotropic medications was compared across the 3 time periods.
  
  
  RESULTS
  Nursing home and assisted living facility residents were older; more disabled, had a higher prevalence of dementia, and greater comorbidity in the latter cohorts. The prevalence of regular opioid use was 11.8% and 22.9% in nursing homes in 2003 and 2011 (P < .001), and 8.6% and 17.3% in assisted living facilities in 2007 and 2011 (P < .001), respectively. The prevalence of regular acetaminophen and pregabalin/gabapentin increased and NSAIDs decreased in both nursing homes and assisted living facilities. The prevalence of regular antipsychotic use decreased from 42.6% to 27.8% in nursing homes (P < .001) but increased from 26.9% to 32.0% in assisted living facilities (P = .0017). The mean number of psychotropic medications (antipsychotics, antidepressants, anxiolytics, hypnotics) per resident decreased from 1.9 in 2003 to 1.0 in 2011 in nursing homes (P < .001) but increased from 1.1 to 1.2 in assisted living facilities (P = .040).
  
  
  CONCLUSIONS
  The prevalence of opioid use in institutional settings has doubled during the past decade. The prevalence of psychotropic medications has decreased in nursing homes but increased in assisted living facilities. The increase in opioid use may reflect improved recognition and treatment of pain. However, initiatives are needed to monitor opioid-related adverse drug events and ensure appropriate use of psychotropic medications, particularly in assisted living facilities.
authors.affiliation: Unit of Primary Health Care, Department of General Practice, and Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland. Electronic address: kaisu.pitkala@helsinki.fi.
authors.forename: Kaisu H
authors.initials: KH
authors.lastname: Pitkala
authors.affiliation: Unit of Primary Health Care, Department of General Practice, and Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland; Health Services, Porvoo, Finland.
authors.forename: Anna-Liisa
authors.initials: AL
authors.lastname: Juola
authors.affiliation: Unit of Primary Health Care, Department of General Practice, and Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland; Tapiola Health Centre, Home Care, Espoo, Finland.
authors.forename: Helka
authors.initials: H
authors.lastname: Hosia
authors.affiliation: Unit of Primary Health Care, Department of General Practice, and Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland.
authors.forename: Mariko
authors.initials: M
authors.lastname: Teramura-Gronblad
authors.affiliation: Social Services and Health Care Department, Helsinki, Finland.
authors.forename: Helena
authors.initials: H
authors.lastname: Soini
authors.affiliation: Unit of Primary Health Care, Department of General Practice, and Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland; Elderly care, Espoo, Finland.
authors.forename: Niina
authors.initials: N
authors.lastname: Savikko
authors.affiliation: Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Melbourne, Australia; School of Pharmacy and Medical Sciences, Sansom Institute, University of South Australia, Adelaide, Australia; Faculty of Health Sciences, Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
authors.forename: J Simon
authors.initials: JS
authors.lastname: Bell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D040561:Assisted Living Facilities; D003430:Cross-Sectional Studies; D004358:Drug Therapy / Q000639:trends*; D017723:Drug Utilization Review; D005260:Female; D005387:Finland; D006801:Humans; D008297:Male; D009735:Nursing Homes; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D013223:Statistics as Topic
chemical_list: D000701:Analgesics, Opioid; D011619:Psychotropic Drugs
keywords: Nursing home; analgesics; opioids; psychotropics; sedative load