Exploring Knowledge, Beliefs, and Attitudes of Older Adults About Prescription Opioids

Abstract Over the past two decades, opioids have been considered important and acceptable in the treatment of pain for older adults, especially for chronic health conditions. Despite the fact that older adults are prescribed opioid medications at high rates, there is little research examining older adults’ knowledge, beliefs, and attitudes about opioid medications. The purpose of this study was to explore the knowledge, beliefs, and attitudes surrounding prescription opioid medications of community living older adults in a southeast area of the United States. A cross-sectional, descriptive, anonymous survey design of participants aged 55 or over was used. Study participants (N=119) reported bias in their attitudes and beliefs about the use and misuse of prescription opioid medications. Multiple regression analyses revealed that gender, age, work, marital status, and education level all had significant results in explaining variance in the statistical models. Even though study participants demonstrated high levels of education and understanding of the potential of addiction to opiates, there were a number of misconceptions revealed about prescription pain medications. This urges the necessity of increased awareness via further research, presentations, and creative discourse to assist in the understanding of precursors of addiction and ways to deal with pain that do not automatically rely on prescription opioid medicines. Implications include outreach to a larger and more diverse sample to address knowledge, beliefs, and attitudes surrounding prescription opioid medications of community living older adults.

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Older adults’ knowledge, beliefs and attitudes about prescription opioids

Advances in Dual Diagnosis ◽

10.1108/add-12-2020-0030 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Susan Glose ◽

Tamatha Arms ◽

Noell Rowan

Keyword(s):

Older Adults ◽

North Carolina ◽

Community Living ◽

Prescription Opioid ◽

Cross Sectional ◽

Content Type ◽

Pain Medications ◽

Opioid Medications ◽

Study Participants ◽

Beliefs And Attitudes

Purpose The purpose of this study is to explore the knowledge, beliefs and attitudes surrounding prescription opioid medications of community living older adults in southeast North Carolina. Design/methodology/approach A cross-sectional, descriptive, anonymous survey design of participants aged 55 or over was used. Findings Study participants (N = 119) reported bias in their attitudes and beliefs about the use and misuse of prescription opioid medications. Multiple regression analyses revealed that gender, age, work, marital status and education level all had significant results in explaining variance in the statistical models. Even though study participants demonstrated high levels of education and understanding of the potential of addiction to opiates, there were a number of misconceptions about prescription pain medications revealed. Originality/value There is a dearth of studies looking at older adults’ knowledge, beliefs and attitudes about prescription pain medications. This urges the necessity of increased awareness via further research, presentations and creative discourse to assist in the understanding of precursors of addiction and ways to deal with pain that do not automatically depend on prescription opioid medicines. Implications include outreach to a larger and more diverse sample to address knowledge, beliefs and attitudes surrounding prescription opioid medications of community living older adults in southeast North Carolina and beyond.

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Knowledge, Beliefs, and Attitudes of Emergency Nurses Toward People With Chronic Pain

SAGE Open Nursing ◽

10.1177/2377960819871805 ◽

2019 ◽

Vol 5 ◽

pp. 237796081987180 ◽

Cited By ~ 1

Author(s):

Geraldine Martorella ◽

Michelle Kostic ◽

Anaïs Lacasse ◽

Glenna Schluck ◽

Laurie Abbott

Keyword(s):

Chronic Pain ◽

Survey Design ◽

The United States ◽

Considerable Proportion ◽

Clinical Environment ◽

Cross Sectional ◽

Complex Needs ◽

Negative Beliefs ◽

Increased Risk ◽

Beliefs And Attitudes

More and more people suffering from chronic pain (CP) utilize the emergency department (ED). However, their needs are not properly addressed. Stigmatization toward people with CP can partially explain this gap. Most studies in the ED have been focused on measuring nurses’ pain management knowledge in general, not negative attitudes toward CP. Hence, understanding of the determinants of the stigma related to CP is needed. The objectives of this study were to (a) describe the knowledge, beliefs, and attitudes of ED nurses toward people suffering from CP and (b) identify nurses’ characteristics associated with these perceptions. A cross-sectional web-based survey design was conducted using the KnowPain-12 questionnaire and the Chronic Pain Myth Scale. A total of 571 participants from 20 different states across the United States were recruited among whom 482 completed the entire survey. The sample included about one third of the ED nurses suffering from CP. Negative beliefs and attitudes toward people with CP were present in a considerable proportion of participants (up to 64%), even in nurses suffering from CP (up to 47.5%). Nevertheless, our results suggest that higher levels of education and suffering from CP were associated with better beliefs and attitudes toward people with CP. The ED presents an increased risk of stigmatization of people with CP as compared with the general population. Identifying determinants of the stigma associated with CP is crucial, as it will help tailoring awareness and educational campaigns. In addition, CP patients utilizing the ED often have complex needs which are difficult to address in this clinical environment. This situation can contribute to negative beliefs and attitudes. Given the scarcity of specialized care clinics for this population, health-care stakeholders should devise solutions to improve continuity of care in primary care settings and between the latter and ED.

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Attitudes and Intention to Work With Older Adults by USA and Israeli Nursing Students: Measure Adaptation and Testing

Innovation in Aging ◽

10.1093/geroni/igaa057.700 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 217-217

Author(s):

Catherine Van Son ◽

Anna Zisberg ◽

Ksenya Shulyaev

Keyword(s):

Older Adults ◽

Nursing Students ◽

Construct Validity ◽

Survey Design ◽

The United States ◽

Original Structure ◽

Validity And Reliability ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Healthcare Needs

Abstract More nurses are needed to meet the healthcare needs of older adults. Valid and reliable measures are lacking that assess attitudes and intentions of nursing students to select a career in geriatrics. This paper discusses the applicability of the Carolina Opinions on Care of Older Adults (COCOA) instrument on attitudes towards and intention to work with older adults among nursing students. A cross-sectional survey design was used with samples of nursing students from the United States (N=122) and Israel (N=109). Students completed the COCOA instrument and the measure’s dimensionality, construct validity, reliability and equivalence among the nursing students was tested. Exploratory Factor Analysis (EFA) produced 5 factors explaining 59% of the variation with most of the items (17, 71%) loading above 0.40 on subscales according to the instrument’s original structure. Four items loaded on different subscales than originally described. One original subscale was eliminated (Value of Older Adults), and one new subscale was created (Older versus Younger Adults). The reliability scores were good to acceptable for all subscales (.60 - .80). Confirmatory FA supported the data’s fit to the modified COCOA instrument (CMIN/DF=1.55, CFI=.93, IFI=.93, RMSEA=.05). The analysis of model equivalence for USA and Israeli samples revealed significant differences attributed to Experience in Caring for Older Adults subscale. The modified COCOA instrument demonstrated good construct validity and reliability and can serve as estimation of nursing students’ attitudes towards older adults and intention to choose geriatrics as a career. Further studies are needed to test its predictive validity.

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Strategic Planning in Emergency Management: Evaluating the Impacts on Local Program Quality

Journal of Homeland Security and Emergency Management ◽

10.1515/jhsem-2019-0051 ◽

2020 ◽

Vol 17 (3) ◽

Author(s):

Scott Robert Manning

Keyword(s):

Strategic Planning ◽

Emergency Management ◽

Survey Design ◽

Management Practice ◽

The United States ◽

Program Quality ◽

County Level ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Local Program

AbstractThis study examined the strategic planning practices of county-level emergency management agencies (EMAs), with a specific focus on strategic planning adoption and its relationship to local program quality. The study utilized a descriptive, cross-sectional survey design to collect planning- and program-related data from more than 300 county-level EMAs across the United States. The study findings revealed that most of the county EMAs included in the final sample had previously engaged in strategic planning activities, with nearly all of them continuing to use strategic planning as part of their general management practice. The study findings further revealed that strategic planning had a direct and significant impact on the overall quality of local emergency management programs, and that the strategic planning EMAs had significantly higher mean quality scores across all program dimensions when compared to the non-strategic planning EMAs.

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Abstract 88: Increasing False Positive Diagnoses May Lead to Overestimation of Stroke Incidence, Particularly in the Young

Stroke ◽

10.1161/str.51.suppl_1.88 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Abhinav J Appukutty ◽

Lesli E Skolarus ◽

Mellanie V Springer ◽

William J Meurer ◽

James F Burke

Keyword(s):

Older Adults ◽

False Positive ◽

Age Groups ◽

Vascular Risk Factor ◽

The United States ◽

Cross Sectional ◽

Stroke Incidence ◽

Ed Visits ◽

Over Time

Introduction: Stroke incidence is reportedly increasing in younger adults. While increasing vascular risk factor prevalence has been suggested as a cause, the reasons for rising stroke incidence in the young are not clear. We explored several alternate explanations: trends in neurologically-focused emergency department (ED) visits, differential diagnostic classification of stroke and TIA over time, and changes in the use of advanced imaging in young and older adults. Methods: We performed a retrospective, serial, cross-sectional study on a nationally representative sample of all ED visits in the United States to quantify changes in patterns of neurologically-focused ED visits, stroke and TIA diagnoses, and rates of MRI utilization for young (18 – 44 years) and older (65+ years) adults over a 17-year period (1995 – 2000; 2005 – 2015) using National Hospital Ambulatory Medical Care Survey (NHAMCS) data. Results: In young adults, 0.4% (95% CI 0.3% – 0.5%) of neurologically-focused ED visits resulted in a primary diagnosis of stroke vs. 6.8% (95% CI 6.2% – 7.5%) for older adults. In both populations, the incidence of neurologically-focused ED visits has increased over time (+111/100,000 population/year, 95% CI +94 – +130 in the young vs. +70/100,000 population/year, 95% CI +34 – +108 in older adults). There was no evidence of differential classification of TIA to stroke over time (OR 1.001 per year, 95% CI 0.926 – 1.083 in the young; OR 1.003 per year, 95% CI 0.982 – 1.026 in older adults) and no evidence of disproportionate rise in MRI utilization for neurologically-focused ED visits in the young (OR 1.057 per year, 95% CI 1.028 – 1.086 in the young; OR 1.095 per year, 95% CI 1.066 – 1.125 in older adults). Conclusions: If the specificity of stroke diagnosis amongst ED visits is similar amongst young and older populations, then the combination of data observed here, including (1) a lower prior probability of stroke diagnoses in the young and (2) an increasing trend in neurologically-focused ED visits in both age groups, suggests that false positive diagnoses will increase over time, with a faster rise in the young compared to older adults. These data suggest a potential explanation that may contribute to higher stroke incidence in the young and merits further scrutiny.

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Patterns of Long-Term Prescription Opioid Use Among Older Adults in the United States: A Study of Medicare Administrative Claims Data

January 2018 - Pain Physician ◽

10.36076/ppj.2021.24.31-40 ◽

2020 ◽

Vol 1;24 (1;1) ◽

pp. 31-40

Keyword(s):

Older Adults ◽

Claims Data ◽

The United States ◽

Prescription Opioid ◽

Administrative Claims ◽

Medicare Beneficiaries ◽

Opioid Use ◽

Opioid Prescription ◽

Administrative Claims Data

BACKGROUND: Long-term opioid therapy was prescribed with increasing frequency over the past decade. However, factors surrounding long-term use of opioids in older adults remains poorly understood, probably because older people are not at the center stage of the national opioid crisis. OBJECTIVES: To estimate the annual utilization and trends in long-term opioid use among older adults in the United States. STUDY DESIGN: Retrospective cohort study. SETTING: Data from Medicare-enrolled older adults. METHODS: This study utilized a nationally representative sample of Medicare administrative claims data from the years 2012 to 2016 containing records of health care services for more than 2.3 million Medicare beneficiaries each year. Medicare beneficiaries who were 65 years of age or older and who were enrolled in Medicare Parts A, B, and D, but not Part C, for at least 10 months in a year were included in the study. We measured annual utilization and trends in new long-term opioid use episodes over 4 years (2013–2016). We examined claims records for the demographic characteristics of the eligible individuals and for the presence of chronic non-cancer pain (CNCP), cancer, and other comorbidities. RESULTS: From 2013 to 2016, administrative claims of approximately 2.3 million elderly Medicare beneficiaries were analyzed in each year with a majority of them being women (~56%) and white (~82%) with a mean age of approximately 75 years. The proportion of all eligible beneficiaries with at least one new opioid prescription increased from 6.64% in 2013, peaked at 10.32% in 2015, and then decreased to 8.14% in 2016. The proportion of individuals with long-term opioid use among those with a new opioid prescription was 12.40% in 2013 and 10.20% in 2016. Among new long-term opioid users, the proportion of beneficiaries with a cancer diagnosis during the study years increased from 13.30% in 2013 to 15.67% in 2016, and the proportion with CNCP decreased from 30.25% in 2013 to 27.36% in 2016. Across all years, long-term opioid use was consistently high in the Southern states followed by the Midwest region. LIMITATIONS: This study used Medicare fee-for-service administrative claims data to capture prescription fill patterns, which do not allow for the capture of individuals enrolled in Medicare Advantage plans, cash prescriptions, or for the evaluation of appropriateness of prescribing, or the actual use of medication. This study only examined long-term use episodes among patients who were defined as opioid-naive. Finally, estimates captured for 2016 could only utilize data from 9 months of the year to capture 90-day long-term-use episodes. CONCLUSIONS: Using a national sample of elderly Medicare beneficiaries, we observed that from 2013 to 2016 the use of new prescription opioids increased from 2013 to 2014 and peaked in 2015. The use of new long-term prescription opioids peaked in 2014 and started to decrease from 2015 and 2016. Future research needs to evaluate the impact of the changes in new and long-term prescription opioid use on population health outcomes. KEY WORDS: Long-term, opioids, older adults, trends, Medicare, chronic non-cancer pain, cancer, cohort study

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Urban-rural differences in the prevalence of muscle weakness and slow gait speed: A cross-sectional analysis from the NHANES (2001-2002 and 2011-2014)

Journal of Aging Research and Lifestyle ◽

10.14283/jarlife.2021.4 ◽

2021 ◽

pp. 1-7

Author(s):

J.J. Aziz ◽

K.F. Reid ◽

J.A. Batsis ◽

R.A. Fielding

Keyword(s):

United States ◽

Older Adults ◽

Grip Strength ◽

Muscle Weakness ◽

Rural Areas ◽

Gait Speed ◽

The United States ◽

Cross Sectional ◽

Comorbidity Burden ◽

Urban Rural

Background: Older adults living in rural areas suffer from health inequities compared to their urban counterparts. These include comorbidity burden, poor diet, and physical inactivity, which are also risk factors for sarcopenia, for which muscle weakness and slow gait speed are domains. To date, no study has examined urban-rural differences in the prevalence of muscle weakness and slow gait speed in older adults living in the United States. Objective: To compare the prevalence of grip strength weakness and slow gait speed between urban and rural older adults living in the United States. Design: A cross-sectional, secondary data analysis of two cohorts from the National Health and Nutrition Examination Survey (NHANES), using gait speed or grip strength data, and urban-rural residency, dietary, examination, questionnaire and demographic data. Participants: 2,923 adults (≥ 60 yrs.). Measures: Grip weakness was defined as either, an absolute grip strength of <35 kg. and <20 kg. or grip strength divided by body mass index (GripBMI) of <1.05 and <0.79 for men and women, respectively. Slow gait speed was defined as a usual gait speed of ≤0.8m/s. Results: The prevalence of GripBMI weakness was significantly higher in urban compared to rural participants (27.4% vs. 19.2%; p=0.001), whereas their absolute grip strength was lower (31.75(±0.45) vs. 33.73(±0.48)). No urban-rural differences in gait speed were observed. Conclusions: Older adults residing in urban regions of the United States were weaker compared to their rural counterparts. This report is the first to describe urban-rural differences in handgrip strength and slow gait speed in older adults living in the United States.

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Associations between elevated growth differentiation factor-15 and sarcopenia among community-dwelling older adults

The Journals of Gerontology Series A ◽

10.1093/gerona/glab201 ◽

2021 ◽

Author(s):

Miji Kim ◽

Jeremy D Walston ◽

Chang Won Won

Keyword(s):

Older Adults ◽

Community Dwelling ◽

Cross Sectional ◽

Baseline Serum ◽

Growth Differentiation Factor 15 ◽

Differentiation Factor ◽

Study Participants ◽

Community Dwelling Older Adults ◽

Prospective Analyses

Abstract Background Growth differentiation factor 15 (GDF-15) is associated with disease progression, mitochondrial dysfunction, and mortality. Elevated GDF-15 level was recently reported to be associated with poorer physical performance in healthy adults. However, the association between serum GDF-15 level and sarcopenia in community-dwelling older adults has not been well characterized. Methods We conducted cross-sectional (n = 929) and two-year prospective analyses (n = 788) among participants aged 70–84 years enrolled in the Korean Frailty and Aging Cohort Study. Participants with an estimated glomerular filtration rate of <60 mL/min/1.73 m 2 were excluded. Appendicular lean mass was measured using dual-energy X-ray absorptiometry. Sarcopenia status was determined according to the Asian Working Group for Sarcopenia-2019 algorithm. Results At baseline, 16.6% of the participants had sarcopenia. Median GDF-15 concentration was higher in the sarcopenic group than in the non-sarcopenic group (1221 pg/mL vs. 1019 pg/mL, p<0.001). In the multivariate analysis adjusted for cardiometabolic risk and biological factors, the highest GDF-15 tertile (≥1245 pg/mL) had an increased likelihood of sarcopenia (odds ratio, 1.96; 95% confidence interval, 1.16–3.33) than the lowest tertile (<885 pg/mL). During the two-year follow-up period, 67 (10.1%) individuals without sarcopenia at baseline developed sarcopenia. There were no significant associations between baseline serum GDF-15 levels and incident sarcopenia or its components (all p>0.05). Conclusions Elevated GDF-15 was associated with prevalent sarcopenia but not able to predict incident sarcopenia in the 2-year follow-up. Further studies are needed to explore the pathophysiological roles of GDF-15 in the development of sarcopenia.

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Neonatal Staff and Advanced Practice Nurses’ Perceptions of Bereavement/End-of-Life Care of Families of Critically Ill and/or Dying Infants

American Journal of Critical Care ◽

10.4037/ajcc2004.13.6.489 ◽

2004 ◽

Vol 13 (6) ◽

pp. 489-498 ◽

Cited By ~ 60

Author(s):

Arthur J. Engler ◽

Regina M. Cusson ◽

Renee T. Brockett ◽

Charlene Cannon-Heinrich ◽

Michelle A. Goldberg ◽

...

Keyword(s):

End Of Life ◽

Critically Ill ◽

End Of Life Care ◽

Survey Design ◽

The United States ◽

Influential Factors ◽

Life Care ◽

Cross Sectional ◽

Neonatal Nurses ◽

Nurses Perceptions

• Background Parents need compassionate care when an infant dies. Nurses can provide such care and possibly facilitate grieving, yet often have inadequate preparation in bereavement/end-of-life care. • Objective To describe neonatal nurses’ perceptions of bereavement/end-of-life care of families of critically ill and/or dying infants. • Methods A cross-sectional, descriptive, correlational mailed survey design was used. The 55-item Bereavement End-of-Life Attitudes About Care: Neonatal Nurses Scale containing 4 sections (comfort, roles, involvement, and demographics) was mailed to 240 hospitals in the United States. • Results The final response rate was 52% (190 completed data sets from 125 hospitals). Respondents were comfortable with many aspects of bereavement/end-of-life care. Comfort and roles scores correlated significantly with number of years as a neonatal intensive care nurse. Respondents agreed about many important aspects of their roles with patients’ families, especially the importance of providing daily support to the families. Most respondents identified caring for a dying infant, the actual death of an infant, and language or cultural differences as influential factors in the level of their involvement with families. • Conclusions Education on bereavement/end-of-life care could affect nurses’ comfort with caring for families of critically ill and/or dying infants. Additional education on cultural competence would be helpful. Educators must promote the inclusion of content on bereavement/end-of-life care in nursing curricula. Finally, researchers must focus more attention on factors that promote and inhibit bereavement/end-of-life care of families of critically ill and/or dying infants.

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