Effects of Pain, Insomnia, and Depression on Psychoactive Medication Supply in Older Adults With Osteoarthritis

Dados Bibliográficos

ID9104936
AutoresMinhui Liu (0009-0008-8911-4405, Center for Innovative Care in Aging, Johns Hopkins University School of Nursing, Baltimore, MD, autor correspondente), Susan M Mccurry (0000-0001-8624-3772, Department of Psychosocial and Community Health, University of Washington School of Nursing), Basia Belza (0000-0003-4934-9214, Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, WA), Diana Taibi Buchanan (0000-0002-5997-0453, University of Washington), Alexandra Dobra (0000-0001-7793-2197, University of Washington), Adrian Dobra (Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, WA), MICHAEL VON KORFF (Kaiser Permanente Washington Health Research Institute, Seattle, WA, autor correspondente), Michael V Vitiello (0000-0002-9776-0473, Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, WA)
Ano2018
Volume56
Fascículo12
Páginas1024-1031
Data de publicação2018-12-01
Peer ReviewedSim
Open AccessNão
TipoARTICLE
PeriódicoMedical Care (JOURNAL)
Identificadores do periódicoISSN: 0025-7079 • E-ISSN: 1537-1948
EditoraOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000000982
PMID30256279
OpenAlexW2893926847
IdiomaEN
Referências citadas38

BACKGROUND: Determinants of prescribing psychoactive medications for symptom management in older adults remain underexamined despite known risks and cautions concerning these medications. OBJECTIVE: To examine independent and combined effects of pain, concurrent insomnia and depression symptoms on psychoactive medications supplied to older adults with osteoarthritis (OA). RESEARCH DESIGN: Survey data on pain, insomnia, and depression obtained from OA patients screened for a randomized controlled trial were used to identify predictors of psychoactive medication supply [opioids, sedatives, tricyclic antidepressants (TCAs), and non-TCAs] over a 4-year period. SUBJECTS: Group Health Cooperative patients with a diagnosis of OA (N=2976). MEASURES: Survey data on pain (Graded Chronic Pain Scale), insomnia (Insomnia Severity Index), and depression (Patient Health Questionnaire-8); and medications supply assessed from electronic medical records. RESULTS: In negative binomial models, pain [incidence rate ratio (IRR), 2.8-3.5; P<0.001], insomnia (IRR, 2.0; P<0.001), and depression (IRR, 1.5; P<0.05) each independently predicted opioid supply. Insomnia (IRR, 3.2; P<0.001) and depression (IRR, 3.0; P<0.001) each independently predicted sedative supply. Pain (IRR, 2.1; P<0.05) and insomnia (IRR, 2.0; P<0.05) independently predicted TCA supply, whereas only depression (IRR, 2.2; P<0.001) independently predicted non-TCA supply. Combined effects of pain and insomnia/depression on these medications were additive and increased the rate of medication supply 1.5-7.5 times. Combined effects increased with insomnia or depression severity. CONCLUSIONS: Concurrent insomnia and depressive symptoms predicted increased supply of opioids, sedatives, and antidepressants after accounting for pain, indicating the importance of sleep and mood disorders as factors increasing supply of these medications

Alternative medicine · Depression (economics) · Insomnia · Osteoarthritis · Physical therapy · Psychiatry · Internal Medicine · Medicine · Musculoskeletal pain and rehabilitation · Osteoarthritis Treatment and Mechanisms · Sleep and related disorders