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2015 HSR&D/QUERI National Conference Abstract

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3023 — Exposure to High Risk Medications is Associated with Worse Outcomes in Older Veterans with Chronic Pain

Makris UE, VA North Texas Health Care System, Dallas, TX ; Depts. of Internal Medicine, UT Southwestern Medical Center, Dallas, TX; Pugh MJ, South Texas Veterans Health Care System, San Antonio, TX. ; University of Texas Health Science Center at San Antonio, San Antonio TX; Alvarez CA, VA North Texas Health Care System, Dallas, TX; Texas Tech University Health Science Center, Dallas TX; Mortensen EM, VA North Texas Health Care System, Dallas, TX; Depts. of Internal Medicine, UT Southwestern Medical Center, Dallas, TX.;

Objectives:
Chronic pain is common, costly, and leads to significant morbidity in older adults, yet we have limited data on medication safety. We sought to evaluate the association of incident High Risk Medication in the Elderly (HRME) with mortality, emergency department (ED) or hospital care among older adults with chronic pain.

Methods:
A retrospective Veterans Health Administration cohort study was conducted examining older Veterans with chronic pain diagnoses and use of incident HRME (opioids, skeletal muscle relaxants, antihistamines, and psychotropics). Outcomes evaluated included all-cause mortality, ED visits, or inpatient hospital care. Secondary outcomes were ED visits or inpatient admissions due to falls or non-spine fractures. Descriptive statistics summarized variables for the overall cohort, the chronic pain cohort, and those with and without HRME. Separate generalized linear mixed-effect regression models were used to examine the association of incident HRME on each outcome, controlling for potential confounders.

Results:
Among the 1,807,404 veterans who received VA care in 2005 and 2006, 584,066 (32.3%) had chronic pain; 45,945 of Veterans with chronic pain (7.9%) had incident HRME exposure. The strongest significant associations of incident HRME were for: high-risk opioids with all-cause hospitalizations (OR 2.08, 95% CI 1.95-2.23) and ED visits related to falls or fractures (OR 2.15, 95% CI 1.78-2.62); skeletal muscle relaxants with all-cause ED visits (OR 2.62, 95% CI 2.52-2.73) and mortality (OR 0.80, 95% CI 0.74-0.86); antihistamines with all-cause ED visits (OR 2.82 95%CI 2.72-2.95) and hospitalizations (OR 2.22, 95% CI 2.12-2.32); and psychotropics with all-cause hospitalizations (OR 2.15, 95% CI 1.96-2.35).

Implications:
Our data indicate that incident HRME is associated with clinically important adverse outcomes in older Veterans with chronic pain and highlight the importance of being judicious with prescribing certain classes of drugs in this vulnerable population.

Impacts:
A better understanding of the outcomes associated with incident HRME in an older chronic pain population is a critical step towards making providers more aware of potentially harmful effects of medications.