(083) Trajectories of Analgesic Agent Use and Adverse Clinical Outcomes Among Older Adults: a Nationwide Cohort Study

Background: As individuals age, the prevalence of pain conditions increases, underscoring the critical need for thorough investigations into analgesic agent use among older adults. Nonetheless, exist sting studies frequently suffer from limitations, such as reliance on cross-sectional designs or narrow focus on a single category of analgesics.

Objectives: This study aims to identify distinct subtypes of trajectories of analgesics among older adults and their associations with mortality and unplanned hospitalizations.

Methods: Using Taiwan's National Health Insurance database, this study identified older adults (aged 65 years or older) without a concomitant diagnosis of cancer who initiated opioids or NSAIDs in 2003 as study participants. Among the eligible study participants, we randomly sampled 50,000 individuals for further analysis. Quarterly consumption of analgesics over a 5-year trajectory period since the initiation of analgesics were retrieved. Utilizing the group-based multi-trajectory model to identify distinct groups of longitudinal use of analgesics (opioids, non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol and other adjuvant agents). The association between these distinct trajectories and clinical outcomes, namely unplanned hospitalization and all-cause mortality, was assessed using Cox proportional hazard models.

Results: Among eligible participants, we identified four distinct subtypes of trajectories in analgesics uses: NSAIDs dominant with increasing opioid use (9.6%), psychotropic agents dominant (14.7%), moderate NSAIDs use (29.1%) and infrequent analgesics use (46.6%). After adjusting for age, sex, and comorbidities, the risk of unplanned hospitalization were highest for psychotropic agents dominant (adjusted hazard ratio (aHR) 1.33; 95% CI 1.27-1.39, p-value < 0.01), followed by NSAIDs dominant with increasing opioid use (aHR 1.26; 95% CI 1.19-1.34, p-value < 0.01) and moderate NSAIDs use (aHR 1.12; 95% CI 1.07-1.16, p-value < 0.01), as compared to infrequent analgesics use. However, only psychotropic agents dominant was associated with increased risk of mortality (aHR 1.29; 95% CI 1.23-1.36, p-value < 0.01).

Conclusions: In older adults, distinct patterns of analgesic use were observed, with varying implications for unplanned hospitalization and mortality. Specifically, trajectories characterized by psychotropic agent dominance were associated with the highest risk of both unplanned hospitalization and mortality. These findings underscore the importance of understanding and monitoring analgesic use patterns in older populations to mitigate adverse health outcomes.