Greater Opioid Use Among Nursing Home Residents in Ontario,Canada During the First 2 Waves of the COVID-19 Pandemic |
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| Affiliation: | 1. School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada;2. ICES, Toronto, Ontario, Canada;3. Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada;4. Division of Geriatric Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada;5. KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada;6. Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada;7. Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada;8. College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada;9. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada |
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| Abstract: | ObjectivesTo examine the association between the COVID-19 pandemic and opioid use among nursing home residents followed up to March 2021, and possible variation by dementia and frailty status.DesignPopulation-based cohort study with an interrupted time series analysis.Setting and ParticipantsLinked health administrative databases for residents of all nursing homes (n = 630) in Ontario, Canada were examined. Residents were divided into consecutive weekly cohorts (first observation week was March 5 to 11, 2017 and last was March 21 to March 27, 2021).MethodsThe weekly proportion of residents dispensed an opioid was examined overall and by strata defined by the presence of dementia and frailty. Autoregressive Integrated Moving Average models with step and ramp intervention functions tested for immediate level and slope changes in weekly opioid use after the onset of the pandemic (March 1, 2020) and were fit on prepandemic data for projected trends.ResultsThe average weekly cohort ranged from 76,834 residents (prepandemic) to 69,359 (pandemic period), with a consistent distribution by sex (69% female) and age (54% age 85 + years). There was a statistically significant increased slope change in the weekly proportion of residents dispensed opioids (parameter estimate (β) = 0.035; standard error (SE) = 0.005, P < .001). Although significant for all 4 strata, the increased slope change was more pronounced among nonfrail residents (β = 0.038; SE = 0.008, P < .001) and those without dementia (β = 0.044; SE = 0.008, P < .001). The absolute difference in observed vs predicted opioid use in the last week of the pandemic period ranged from 1.25% (frail residents) to 2.28% (residents without dementia).Conclusions and ImplicationsAmong Ontario nursing home residents, there was a statistically significant increase in opioid dispensations following the onset of the pandemic that persisted up to 1 year later. Investigations of the reasons for increased use, potential for long-term use and associated health consequences for residents are warranted. |
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| Keywords: | COVID-19 opioid use nursing home time-series analysis |
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