title: Analgesic prescribing patterns in Norwegian nursing homes from 2000 to 2011: trend analyses of four data samples.
abstract: BACKGROUND
  the analgesic drug use has been reported to increase in general in nursing home patients. However, there is insufficient evidence in terms of what agents are used, variations of use over time and to whom these drugs are prescribed.
  
  
  OBJECTIVE
  we investigated the prescribing patterns of scheduled analgesic drugs in Norwegian nursing home patients from 2000 to 2011, with the association to age, gender, cognitive function and type of nursing home unit.
  
  
  METHODS
  secondary analyses of four study samples (three observational studies and one randomised controlled trial).
  
  
  METHODS
  nursing home patients included in study samples from 2000 (n = 1,926), 2004 (n = 1,163), 2009 (n = 850) and 2011 (n = 1,858) located in 14 Norwegian counties.
  
  
  METHODS
  trend analyses of analgesic drug prescriptions. Percentages were described using t-test, χ(2) and Mann-Whitney U test and multivariate logistic regression.
  
  
  RESULTS
  the odds ratio for receiving any pain medication in 2011 compared with 2000 was 2.6 (95% CI 2.23-2.91), this is corresponding to a 65% increase from 34.9 to 57.6%. The paracetamol prescription increased by 113%, from 22.7% in 2000 to 48.4% in 2011. Strong opioids (fentanyl, buprenorphine, morphine, oxycodone) increased from 1.9% in 2000 to 17.9% in 2011 (P < 0.001), whereas non-steroidal anti-inflammatory drug prescription decreased, from 6.8 to 3.2%. In 2000, 2004 and 2009, people with dementia received fewer analgesics compared with patients without dementia; no differences in analgesic drug use between the groups were found in 2011.
  
  
  CONCLUSIONS
  the analgesic drug prescription increased significantly from 2000 to 2011, especially the use of paracetamol and strong opioids. We also highlight a possible change from under-prescription of analgesic medication in people with dementia, to an equal amount compared with patients without cognitive impairment.
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors.forename: Reidun
authors.initials: R
authors.lastname: Sandvik
authors.affiliation: National Advisory Unit on Ageing and Health, Oslo Universitetssykehus HF, Oslo, Norway.
authors.forename: Geir
authors.initials: G
authors.lastname: Selbaek
authors.affiliation: National Advisory Unit on Ageing and Health, Oslo Universitetssykehus HF, Oslo, Norway The Alzheimer's Society Systematic Review Group.
authors.forename: Oyvind
authors.initials: O
authors.lastname: Kirkevold
authors.affiliation: Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Dag
authors.initials: D
authors.lastname: Aarsland
authors.forename: Bettina Sandgathe
authors.initials: BS
authors.lastname: Husebo
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology; D000700:Analgesics / Q000627:therapeutic use*; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D016009:Chi-Square Distribution; D003071:Cognition; D003704:Dementia / Q000523:psychology; D011307:Drug Prescriptions; D017723:Drug Utilization Review; D005260:Female; D006707:Homes for the Aged / Q000639:trends*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009664:Norway; D009735:Nursing Homes / Q000639:trends*; D064887:Observational Studies as Topic; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000639:trends*; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors
chemical_list: D000700:Analgesics; D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000082:Acetaminophen
keywords: analgesics; dementia; nursing home; older people; pain; pain medication