title: Exposure to High-Risk Medications is Associated With Worse Outcomes in Older Veterans With Chronic Pain.
abstract: BACKGROUND
  Chronic pain is common, costly and leads to significant morbidity in older adults, yet there are limited data on medication safety. The authors sought to evaluate the association of incident high-risk medication in the elderly (HRME) with mortality, emergency department (ED) or hospital care among older adults with chronic pain.
  
  
  METHODS
  A retrospective Veterans Health Administration cohort study was conducted examining older veterans with chronic pain diagnoses and use of incident HRME (opioids, skeletal muscle relaxants, antihistamines and psychotropics). Outcomes evaluated included all-cause mortality, ED visits or inpatient hospital care. Descriptive statistics summarized variables for the overall cohort, the chronic pain cohort and those with and without HRME. Separate generalized linear mixed-effect regression models were used to examine the association of incident HRME on each outcome, controlling for potential confounders.
  
  
  RESULTS
  Among 1,807,404 veterans who received Department of Veterans Affairs care in 2005 to 2006, 584,066 (32.3%) had chronic pain; 45,945 veterans with chronic pain (7.9%) had incident HRME exposure. The strongest significant associations of incident HRME were for high-risk opioids with all-cause hospitalizations (odds ratio [OR] 2.08, 95% confidence interval [CI] 1.95-2.23), skeletal muscle relaxants with all-cause ED visits (OR 2.62, 95% CI 2.52-2.73) and mortality (OR 0.80, 95% CI 0.74-0.86), antihistamines with all-cause ED visits (OR 2.82 95% CI 2.72-2.95) and psychotropics with all-cause hospitalizations (OR 2.15, 95% CI 1.96-2.35).
  
  
  CONCLUSIONS
  Our data indicate that incident HRME is associated with clinically important adverse outcomes in older veterans with chronic pain and highlight the importance of being judicious with prescribing certain classes of drugs in this vulnerable population.
authors.affiliation: VA North Texas Health Care System (UEM, CAA, EMM), Dallas, Texas; University of Texas Southwestern Medical Center (UEM, CAA, EMM), Dallas, Texas; South Texas Veterans Health Care System (MJP), San Antonio, Texas; Texas Tech University Health Science Center (CAA), Dallas, Texas; University of Texas Health Science Center at San Antonio (MJP, BJT, KA), San Antonio, Texas; and Edith Nourse Rogers Memorial Veterans Hospital (DRB), Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts.
authors.forename: Una E
authors.initials: UE
authors.lastname: Makris
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Pugh
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Alvarez
authors.forename: Dan R
authors.initials: DR
authors.lastname: Berlowitz
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Turner
authors.forename: KoKo
authors.initials: K
authors.lastname: Aung
authors.forename: Eric M
authors.initials: EM
authors.lastname: Mortensen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000150:complications* / Q000188:drug therapy*; D015331:Cohort Studies; D004358:Drug Therapy; D004636:Emergency Service, Hospital; D005260:Female; D006304:Health Status; D006801:Humans; D015994:Incidence; D008297:Male; D016017:Odds Ratio; D019338:Polypharmacy; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans; D035862:Vulnerable Populations