OBJECTIVES: National information on opioid use in long-term care nursing homes is unknown. We examined the temporal trends in opioid use and the association of dementia severity with opioid use in long-term care nursing home residents.

METHODS: This retrospective study used 20% national Minimum Data Set and Medicare claims from 2011-2017. For primary analysis, we selected long-term care residents with moderate to severe pain (n=16,855). In a secondary analysis, we included nursing home residents who had an emergency room visit for a fracture (n=12,860). Among nursing home residents with moderate to severe pain, association of dementia severity with any, prolonged (>90 days) and high-dose (≥90 morphine milligram equivalent [MME] dose/day) opioid use was evaluated using logistic regression. Among nursing home residents with a fracture, we determined if they received at least one prescription of an opioid within 7 days after emergency room discharge. We controlled for patient's sociodemographic and clinical characteristics, and nursing home characteristics.

RESULTS: Opioid use declined from 47.8% in 2012 to 40.3% in 2017 (p=0.0007) in residents with severe dementia with a fracture. Among nursing home residents with moderate to severe pain (n=16,855), 72.7% used at least one opioid, 37.3% used for over 90 days and 4.1% used high-dose opioids. Severe dementia reduced the odds of any (66.6% vs. 76.4%; OR=0.85, 95%CI=0.79-0.91), prolonged (30.5% vs. 41.9%; OR=0.91, 95%CI=0.82-0.99) and high-dose (2.1% vs. 5.7%; OR=0.55, 95%CI=0.44-0.70) opioid use. After fracture, moderate (40.7% vs. 48.9%; OR=0.70, 95% CI=0.63-0.78) and severe (43.5 vs. 48.9%; OR=0.80, 95% CI=0.73-0.88) reduced opioid use.

CONCLUSIONS: Severe dementia reduces opioid use and may reflect under-recognition and under-treatment of pain in this population. To improve quality of care, systemic efforts from healthcare professionals, nursing home administrators and policymakers are needed to evaluate opioid use in nursing home residents with dementia.