Home › Research › Costs and economics
Longitudinal Pain Management Patterns and Risk of Adverse Outcomes in Older Adults: Insights from Group-Based Multi-Trajectory Modeling
Chen I, Huang S, Liang C, Chou M, Loh C, Chen L, Hsiao F.. Authorea Preprints, 2024-12-28
Topic: Health services, long-term care and technology
Aim: The long-term impact of different pain management strategies in older adults remains poorly understood. This population-based retrospective cohort study aimed to identify distinct trajectories of pain management utilization and examine their associations with adverse clinical outcomes in older adults, stratified by frailty status. Methods Using Taiwan’s National Health Insurance Database, we included older adults (≥65 years) who initiated NSAIDs in 2010 and followed them for 8 years. Group-based multi-trajectory modeling and Cox proportional hazards models were employed to assess associations between trajectory groups and subsequent clinical outcomes. Results Among 24,539 participants (mean age 72.7, 58.9% female), four distinct trajectories were identified: short-term (27.6%), mild (31.9%), moderate (21.7%), and extensive (18.9%) utilization. Compared to the short-term group, the extensive utilization group had significantly higher risks of unplanned hospitalization (adjusted HR: 1.36, 95% CI 1.24–1.48), all-cause hospitalization (aHR: 1.43, 95% CI 1.34–1.52), and incident dementia (aHR: 1.27, 95% CI 1.04–1.54). For dialysis, only the extensive group showed higher risk in the age-sex adjusted model (HR: 2.06, 95% CI: 1.00-4.22), but significance was lost after frailty adjustment. No significant differences in all-cause mortality were observed after full adjustment. Conclusion These findings highlight that extensive long-term utilization of pain management strategies in older adults is associated with increased risks of adverse outcomes, particularly hospitalizations and incident dementia, especially among fit older adults, emphasizing the need for careful monitoring and personalized approaches to pain management in older populations, balancing effective pain control with minimization of potential long-term risks.
Key findings
- Results Among 24,539 participants (mean age 72.7, 58.9% female), four distinct trajectories were identified: short-term (27.6%), mild (31.9%), moderate (21.7%), and extensive (18.9%) utilization.
- Compared to the short-term group, the extensive utilization group had significantly higher risks of unplanned hospitalization (adjusted HR: 1.36, 95% CI 1.24–1.48), all-cause hospitalization (aHR: 1.43, 95% CI 1.34–1.52), and incident dementia (aHR: 1.27, 95% CI 1.04–1.54).
- For dialysis, only the extensive group showed higher risk in the age-sex adjusted model (HR: 2.06, 95% CI: 1.00-4.22), but significance was lost after frailty adjustment.
- No significant differences in all-cause mortality were observed after full adjustment.
- Conclusion These findings highlight that extensive long-term utilization of pain management strategies in older adults is associated with increased risks of adverse outcomes, particularly hospitalizations and incident dementia, especially among fit older adults, emphasizing the need for careful monitoring and personalized approaches to pain management in older populations, balancing effective pain control with minimization of potential long-term risks.
New to this subject? Start with our plain-English guide: Costs & economics →
Study details
- Study designcohort study
- Participants24,539
- Effect size58.9%; 27.6%; 31.9%
- Evidence strengthModerate
How this study scored 16/100
Preprint — not yet peer-reviewed. It scored 48 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. Scored zero for randomised / blinded because the record does not state it. We have no data on times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 30 of the 62 points we could judge it on, which is 48 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (Authorea Preprints) |
| Journal's citation record | 0 / 4 | Not a journal article, so the journal's record does not count |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 4 / 10 | Preprint — not yet peer-reviewed. Hosted on a preprint server. |
| How recent | 4 / 5 | 2024 — within 3 year(s) of the newest study here |
| Sample size | 4 / 4 | 24,539 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 30 / 62 | Scored on 12 of 20 parts. We have no data for the rest, so they are left out: 30 of the 62 points we could judge it on is 48 out of 100. |
| Total | 48 / 100 | Capped to 16 because this is not a peer-reviewed article. |
What each of these 20 components measures, and what this score is not →
Read the original
Free copy unknown: no free-copy check has an answer for this record yet. That does not mean it is paywalled.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record names 7 authors; APA and Vancouver show the first six, BibTeX and the downloads carry all of them. Check the citation against the original before you use it.
APA 7th
Chen, I., Huang, S., Liang, C., Chou, M., Loh, C., Chen, L., et al. (2024). Longitudinal Pain Management Patterns and Risk of Adverse Outcomes in Older Adults: Insights from Group-Based Multi-Trajectory Modeling. Authorea Preprints. https://doi.org/10.22541/au.173535335.52257521/v1
Vancouver
Chen I, Huang S, Liang C, Chou M, Loh C, Chen L, et al. Longitudinal Pain Management Patterns and Risk of Adverse Outcomes in Older Adults: Insights from Group-Based Multi-Trajectory Modeling. Authorea Preprints. 2024. doi:10.22541/au.173535335.52257521/v1.
BibTeX
@article{chen2024-4004f8d4,
author = {Chen, I. and Huang, S. and Liang, C. and Chou, M. and Loh, C. and Chen, L. and Hsiao, F.},
title = {{Longitudinal Pain Management Patterns and Risk of Adverse Outcomes in Older Adults: Insights from Group-Based Multi-Trajectory Modeling}},
journal = {Authorea Preprints},
year = {2024},
doi = {10.22541/au.173535335.52257521/v1},
url = {https://doi.org/10.22541/au.173535335.52257521/v1}
}