scholarly journals Association of co-prescribing of opioid and benzodiazepine substitutes with incident falls and fractures among older adults: a cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e052057
Author(s):  
Rahul Shah ◽  
Mukaila A Raji ◽  
Jordan Westra ◽  
Yong-Fang Kuo
Keyword(s):  
Chronic Pain ◽  
Cohort Study ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Propensity Scores ◽  
Secondary Analysis ◽  
Medicare Beneficiaries ◽  
Combination Drug ◽  
Drug Classes ◽  
Risk Of Falls ◽  
Drug Regimens

ObjectiveExamine the association between the co-prescribing of opioids, benzodiazepines, gabapentinoids (pregabalin and gabapentin) and selective serotonin reuptake inhibitors/serotonin and norepinephrine reuptake inhibitors (SSRI/SNRIs) in different combinations and the risk of falls and fractures.DesignRetrospective cohort study from 2015 to 2018.SettingMedicare enrolment and claims data.ParticipantsMedicare beneficiaries with both chronic pain and anxiety disorders in 2016 with continuous enrolments in Parts A and B from 2015 to 2016 who were prescribed any combination of opioid, benzodiazepine, gabapentinoid and SSRI/SNRI in 2017 for ≥7 days, as documented in their Medicare Part D coverage.InterventionsAny combination of use of seven drug regimens (benzodiazepine +opioid; benzodiazepine +gabapentinoid; benzodiazepine +SSRI/SNRI; opioid +gabapentinoid; opioid +SSRI/SNRI; gabapentinoid +SSRI/SNRI; ≥3 drug classes).Main outcomesFirst event of fall and the first event of fracture after the index date, which was the first day of combination drug use that lasted ≥7 days in 2017.ResultsA total of 47 964 patients (mean [SD] age, 75.9 [7.1]; 78.0% woman) with diagnoses of both chronic pain and anxiety were studied. The median (Q1–Q3) duration of drug combination use was 26 (14-30) days. After adjusting for demographic characteristics, chronic conditions and history of hospitalisation and fall or fracture, the co-prescribing of ≥3 drugs (adjusted HR [aHR], 1.38; 95% CI 1.14 to 1.67) and opioid plus gabapentinoid (aHR, 1.18; 95% CI 1.02 to 1.37) were associated with a high fall risk, compared with benzodiazepineplus opioid co-prescribing, findings consistent with the secondary analysis using inverse probability of treatment weighting with propensity scores. The co-prescribing of benzodiazepine plus gabapentinoid (aHR, 0.76; 95% CI 0.59 to 0.98) was associated with lower fracture risk compared with the co-prescribing of benzodiazepine plus opioid, though this finding was not robust.ConclusionsOur findings add to comparative toxicity research on different combinations of gabapentinoids and serotonergic agents commonly prescribed with or as substitutes for opioids and benzodiazepines in patients with co-occurring chronic pain and anxiety.

scholarly journals The Association Between Preoperative Pain Catastrophizing and Chronic Pain After Hysterectomy – Secondary Analysis of a Prospective Cohort Study

2020 ◽  
Vol Volume 13 ◽  
pp. 2151-2162
Author(s):  
Hon Sen Tan ◽  
Rehena Sultana ◽  
Nian-Lin Reena Han ◽  
Chin Wen Tan ◽  
Alex Tiong Heng Sia ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Pain Catastrophizing ◽  
Secondary Analysis ◽  
Preoperative Pain

scholarly journals Dysphagia Prevalence, Time Course, and Association with Probable Sarcopenia, Inactivity, Malnutrition, and Disease Status in Older Patients Admitted to an Emergency Department: A Secondary Analysis of Cohort Study Data

Geriatrics ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 46
Author(s):  
Tina Hansen ◽  
Rikke Lundsgaard Nielsen ◽  
Morten Baltzer Houlind ◽  
Juliette Tavenier ◽  
Line Jee Hartmann Rasmussen ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Cohort Study ◽  
Systemic Inflammation ◽  
Older Patients ◽  
Time Course ◽  
Assessment Tool ◽  
Handgrip Strength ◽  
Secondary Analysis ◽  
Disease Status

There is evolving evidence for an association between dysphagia and sarcopenia in older adults. For optimizing the acute health care initiative across health care settings, this study investigated prevalence and time-course of dysphagia in older patients admitted to an emergency department (ED) as well as its association with parameters for probable sarcopenia, inactivity, malnutrition, disease status, and systemic inflammation. A secondary analysis of data from the FAM-CPH cohort study on acutely admitted older medical patients (n = 125). Data were collected upon ED admission as well as four and 56 weeks after discharge. Using the Eating Assessment Tool cut-off score ≥ 2, signs of dysphagia were present in 34% of the patients at ED admission and persisted in 25% of the patients 56 weeks after discharge. Signs of dysphagia at 56-week follow-up were significantly (p < 0.05) associated with probable sarcopenia (low handgrip strength (OR = 3.79), low leg muscle strength (OR = 8.14), and low physical performance (OR = 5.68)) and with baseline swallowing inactivity (OR = 5.61), malnutrition (OR = 4.35), and systemic inflammation (OR = 1.33). Signs of dysphagia in older patients admitted to an ED was prevalent, persisted 56 weeks after discharge, and was associated with probable sarcopenia and related conditions; all modifiable targets for management of dysphagia in older patients.

scholarly journals Timing of Home Health Care Initiation and 30-Day Rehospitalizations among Medicare Beneficiaries with Diabetes by Race and Ethnicity

2021 ◽  
Vol 18 (11) ◽  
pp. 5623
Author(s):  
Jamie M. Smith ◽  
Haiqun Lin ◽  
Charlotte Thomas-Hawkins ◽  
Jennifer Tsui ◽  
Olga F. Jarrín
Keyword(s):  
Health Care ◽  
Home Health Care ◽  
Race And Ethnicity ◽  
Health Care Services ◽  
Propensity Scores ◽  
The United States ◽  
Home Health ◽  
Medicare Beneficiaries ◽  
Timely Initiation ◽  
Care Services

Older adults with diabetes are at elevated risk of complications following hospitalization. Home health care services mitigate the risk of adverse events and facilitate a safe transition home. In the United States, when home health care services are prescribed, federal guidelines require they begin within two days of hospital discharge. This study examined the association between timing of home health care initiation and 30-day rehospitalization outcomes in a cohort of 786,734 Medicare beneficiaries following a diabetes-related index hospitalization admission during 2015. Of these patients, 26.6% were discharged to home health care. To evaluate the association between timing of home health care initiation and 30-day rehospitalizations, multivariate logistic regression models including patient demographics, clinical and geographic variables, and neighborhood socioeconomic variables were used. Inverse probability-weighted propensity scores were incorporated into the analysis to account for potential confounding between the timing of home health care initiation and the outcome in the cohort. Compared to the patients who received home health care within the recommended first two days, the patients who received delayed services (3–7 days after discharge) had higher odds of rehospitalization (OR, 1.28; 95% CI, 1.25–1.32). Among the patients who received late services (8–14 days after discharge), the odds of rehospitalization were four times greater than among the patients receiving services within two days (OR, 4.12; 95% CI, 3.97–4.28). Timely initiation of home health care following diabetes-related hospitalizations is one strategy to improve outcomes.

scholarly journals Parental incarceration affects children’s emotional and behavioral outcomes: A longitudinal cohort study of children aged 9 to 13 years

2021 ◽  
pp. 016502542199591
Author(s):  
Daragh Bradshaw ◽  
Ann-Marie Creaven ◽  
Orla T. Muldoon
Keyword(s):  
Cohort Study ◽  
Relationship Quality ◽  
Child Outcomes ◽  
Behavioral Outcomes ◽  
Secondary Analysis ◽  
Parental Incarceration ◽  
Child Relationship ◽  
Children And Parents ◽  
The Impact

Parental incarceration (PI) is negatively associated with emotional, educational, and psychological child outcomes. However, few studies explore potential mechanisms through which these outcomes are transmitted or the means by which prosocial outcomes might develop. This study used data from two waves of a population cohort study of children aged 9 years and followed up aged 13 years living in Ireland. Children and parents ( N = 8,568) completed measures of PI, primary caregiver (PCG) depression, PCG-child relationship quality, and child behavioral adjustment. We then conducted a secondary analysis on this national longitudinal study of children in Ireland. Using sequential mediation models, we observed a mediated indirect effect of PI on prosocial outcomes via PCG depression and PCG-child relationship quality. PI at age 9 was associated with increased difficulties and reduced prosocial behavior at age 13. Additionally, PI at age 9 affected PCG depression and the PCG-child relationship quality. Additionally, child prosocial outcomes, and emotional and behavioral difficulties were less apparent where PI had a weaker effect on PCG depression and the quality of PCG-child relationship. Supports that can mitigate the impact of PI for vulnerable caregivers and children are discussed.

scholarly journals Risk of 30-day hospital readmission associated with medical conditions and drug regimens of polymedicated, older inpatients discharged home: a registry-based cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e052755
Author(s):  
Filipa Pereira ◽  
Henk Verloo ◽  
Taushanov Zhivko ◽  
Saviana Di Giovanni ◽  
Carla Meyer-Massetti ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Drug Regimen ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Day Hospital ◽  
Medical Conditions ◽  
Older Inpatients ◽  
Drug Regimens

ObjectivesThe present study analysed 4 years of a hospital register (2015–2018) to determine the risk of 30-day hospital readmission associated with the medical conditions and drug regimens of polymedicated, older inpatients discharged home.DesignRegistry-based cohort study.SettingValais Hospital—a public general hospital centre in the French-speaking part of Switzerland.ParticipantsWe explored the electronic records of 20 422 inpatient stays by polymedicated, home-dwelling older adults held in the hospital’s patient register. We identified 13 802 hospital readmissions involving 8878 separate patients over 64 years old.Outcome measuresSociodemographic characteristics, medical conditions and drug regimen data associated with risk of readmission within 30 days of discharge.ResultsThe overall 30-day hospital readmission rate was 7.8%. Adjusted multivariate analyses revealed increased risk of hospital readmission for patients with longer hospital length of stay (OR=1.014 per additional day; 95% CI 1.006 to 1.021), impaired mobility (OR=1.218; 95% CI 1.039 to 1.427), multimorbidity (OR=1.419 per additional International Classification of Diseases, 10th Revision condition; 95% CI 1.282 to 1.572), tumorous disease (OR=2.538; 95% CI 2.089 to 3.082), polypharmacy (OR=1.043 per additional drug prescribed; 95% CI 1.028 to 1.058), and certain specific drugs, including antiemetics and antinauseants (OR=3.216 per additional drug unit taken; 95% CI 1.842 to 5.617), antihypertensives (OR=1.771; 95% CI 1.287 to 2.438), drugs for functional gastrointestinal disorders (OR=1.424; 95% CI 1.166 to 1.739), systemic hormonal preparations (OR=1.207; 95% CI 1.052 to 1.385) and vitamins (OR=1.201; 95% CI 1.049 to 1.374), as well as concurrent use of beta-blocking agents and drugs for acid-related disorders (OR=1.367; 95% CI 1.046 to 1.788).ConclusionsThirty-day hospital readmission risk was associated with longer hospital length of stay, health disorders, polypharmacy and drug regimens. The drug regimen patterns increasing the risk of hospital readmission were very heterogeneous. Further research is needed to explore hospital readmissions caused solely by specific drugs and drug–drug interactions.

Pain memory in patients with chronic pain versus asymptomatic individuals: A prospective cohort study

2020 ◽  
Vol 24 (9) ◽  
pp. 1741-1751
Author(s):  
Roy La Touche ◽  
Alba Paris‐Alemany ◽  
Luis Suso‐Martí ◽  
Noelia Martín‐Alcocer ◽  
Francisco Mercado ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Pain Memory ◽  
Asymptomatic Individuals

scholarly journals Paternal prescription medication before conception: A retrospective cohort study of all births in Denmark 1997–2017

2021 ◽  
pp. 140349482098746
Author(s):  
M.J. Wensink ◽  
S. Rizzi ◽  
T.K. Jensen ◽  
N.E. Skakkebaek ◽  
Y. Lu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Sperm Quality ◽  
Prescription Medication ◽  
Pain Medication ◽  
Potential Harm ◽  
Generational Effects ◽  
Medication Exposure

Aim: To study what medication fathers are being prescribed in the months preceding conception. Methods: A retrospective cohort study of Danish national registries, comprising all births in Denmark 1997–2017 (1.3 million births). Time trends and absolute levels of paternal prescription medication in the 6 months prior to conception were assessed. While all medications were examined ( N = 1335), we focused on the main medication groups, medications that have increased in use over time, and medications for which previous evidence exists of an effect on sperm quality. Results: The average number of prescriptions increased over the study period (from 0.75 prescriptions to 0.82 per birth). Polypharmacy (three or more prescriptions) increased from less than 8% to 10% of fathers. The use of pain medication, proton-pump inhibitors, selective serotonin reuptake inhibitors and some inhalants have all increased markedly over the last 20 years. Conclusions: Potential harm to the offspring done by paternal medication may present an increasing problem. As paternal medication exposure is increasing, examination of generational effects, such as major birth defects, is necessary.

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