Background & Aims

Problematic use of opioids by older adults is associated with several adverse effects and has become a public health crisis worldwide. Associated factors to opioid use in elderly from Latin America are unexplored. Ageing-related difficulties in activities of daily living (ADL) could promote unnecessary use of opioids in this population. However, this association has not been tested. This study evaluated the association between ADL difficulties and opioid consumption in Brazilian older adults.

Methods

Data from the second wave of the Brazil Longitudinal Study of Ageing (ELSI-Brazil) was used. Older adults with chronic pain were included. ADL impairment was measured using the Katz Index. The primary outcome was opioid consumption for chronic pain within three months preceding the interview. Exploratory regression models with random splits were developed and adjusted for demographics and other comorbidities.

Results

In those who reported the presence of chronic pain (n=2,865), the prevalence of opioid use was 29% (95% CI:23.1%–35.6%). In adjusted models, participants with moderate and severe impairment in ADL had 1.6 (95% CI-1.13-2.32; p=0.009) and 3.8 (95% CI: 1.80 to 7.90; p<0.001) times higher odds of opioid consumption compared to no impairment, respectively. Being female, alcohol consumption, higher pain intensity, history of dementia, fractures in the past 12 months, and presence of more than two comorbidities were significantly associated with increased opioid use (p<0.05). Socioeconomic status and pain intensity were not effect modifiers.

Conclusions

Nearly one-third of the Brazilian elderly population experiencing chronic pain reported using opioids. The functional decline during the process of aging appears to be a risk factor for pain intolerance and opioid use. Multidisciplinary approaches to detect early ADL impairments and improve mobility and access to assistive technologies need to be established to prevent opioid overuse and addiction in elderly populations.

References

1.World population ageing, 2019 highlights [Internet]. New York: United Nations; 2020. Available from: https://digitallibrary.un.org/record/3846855?ln=en
2.Instituto Brasileiro de Geografia e Estatística IBGE. Censo 2022 [Internet]. Instituto Brasileiro de Geografia e Estatística; 2023 [cited 2023 Oct 30]. Available from: https://biblioteca.ibge.gov.br/index.php/biblioteca-catalogo?view=detalhes&id=73102
3.Cigolle CT, Langa KM, Kabeto MU, Tian Z, Blaum CS. Geriatric conditions and disability: the Health and Retirement Study. Ann Intern Med. 2007 Aug 7;147(3):156–64.
4.Henschke N, Kamper SJ, Maher CG. The epidemiology and economic consequences of pain. Mayo Clin Proc. 2015 Jan;90(1):139–47.
5.Ferretti F, Silva MRD, Pegoraro F, Baldo JE, Sá CAD. Chronic pain in the elderly, associated factors and relation with the level and volume of physical activity. Br J Pain. 2019;2(1):3–7.
6.Mullachery PH, Lima-Costa MF, De Loyola Filho A.I. Prevalence of pain and use of prescription opioids among older adults: results from the Brazilian Longitudinal Study of Aging (ELSI-Brazil). The Lancet Regional Health – Americas. 2023 Apr;20:100459.

Presenting Author

Kevin Pacheco-Barrios

Poster Authors

Kevin Pacheco-Barrios

MD, MPH, MSc

Spaulding Rehabilitation Hospital, Harvard Medical School.

Lead Author

E-mail

Juan Carlos Silva Godinez

Instituto Mexicano del Seguro Social

Lead Author

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Fathima Minisha

Hamad Medical Corporation

Lead Author

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Taís Daiene Russo Hortencio

Instituto de Pesquisa São Leopoldo Mandic

Lead Author

E-mail

Adriana Innocenzi

Federal University of Rio de Janeiro

Lead Author

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Caio Cesar dos Santos Kasai

Pontifícia Universidade Católica do Paraná

Lead Author

E-mail

Mariana Povoa-Correa

Federal Institute of Cardiology

Lead Author

E-mail

Felipe Fregni

Spaulding Rehabilitation Hospital, Harvard Medical School

Lead Author

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Topics

  • Epidemiology