ArticleJournal of the American Medical Directors Association2017
Inappropriate Fentanyl Prescribing Among Nursing Home Residents in the United States.
Article in Journal of the American Medical Directors Association, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed, 18 citations in OpenAlex.
- The relationship between pain, sleep quality, and care dependency in older adults living in a long-term care facility.BMC geriatrics · 2025Article
- Patient safety incidents involving transdermal opioids: data from the Danish Patient Safety Database.International journal of clinical pharmacy · 2021Article
- Opioid Prescribing in the Elderly: A Systematic Review.The Journal of pharmacy technology : jPT : official publication of the Association of Pharmacy Technicians · 2020Review
- Pain Assessment, Management, and Impact Among Older Adults in Assisted Living.Pain management nursing : official journal of the American Society of Pain Management Nurses · 2019Review
- Long-acting opioid initiation in US nursing homes.Pharmacoepidemiology and drug safety · 2019Article
- Facility and State Variation in Hip Fracture in U.S. Nursing Home Residents.Journal of the American Geriatrics Society · 2018Article
- Prevalence of Long-Term Opioid Use in Long-Stay Nursing Home Residents.Journal of the American Geriatrics Society · 2018Article
- Article
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
Abstract
objectiveWe quantified transdermal fentanyl prescribing in elderly nursing home residents without prior opioid use or persistent pain, and the association of individual and facility traits with opioid-naïve prescribing.
designCross-sectional study.
settingLinked Minimum Data Set (MDS) assessments; Online Survey, Certification and Reporting (OSCAR) records; and Medicare Part D claims.
participantsFrom a cross-section of all long-stay US nursing home residents in 2008 with an MDS assessment and Medicare Part D enrollment, we identified individuals (≥65 years old) who initiated transdermal fentanyl, excluding those with Alzheimer disease, severe cognitive impairment, cancer, or receipt of hospice care. MEASUREMENTS: We used Medicare Part D to select beneficiaries initiating transdermal fentanyl in 2008 and determined whether they were "opioid-naïve," defined as no opioid dispensing during the previous 60 days. We obtained resident and facility characteristics from MDS and OSCAR records and defined persistent pain as moderate-to-severe, daily pain on consecutive MDS assessments at least 90 days apart. We estimated associations of patient and facility attributes and opioid-naïve fentanyl initiation using multilevel mixed effects logistic regression modeling.
resultsAmong 17,052 residents initiating transdermal fentanyl, 6190 (36.3%) were opioid-naïve and 15,659 (91.8%) did not have persistent pain. In the regression analysis with adjustments, residents who were older (ages ≥95 odds ratio [OR] 1.69, 95% confidence interval [CI] 1.46-1.95) or more cognitively impaired (moderate-to-severe cognitive impairment, OR 1.99, 95% CI 1.73-2.29) were more likely to initiate transdermal fentanyl without prior opioid use.
conclusionMost nursing home residents initiating transdermal fentanyl did not have persistent pain and many were opioid-naïve. Changes in prescribing practices may be necessary to ensure Food and Drug Administration warnings are followed, particularly for vulnerable subgroups, such as the cognitively impaired.
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