Table 1.
Individual characteristics of long-stay residents initiating opioids in 2011, overall and stratified by opioid initiated (N=62,889 residents in 12,345 facilities within 298 hospital referral regions).
| Stratified by opioid initiated |
||||
|---|---|---|---|---|
| Characteristic1, % | Overall (N=62,889) |
Oxycodone (n=5,891) |
Hydrocodone (n=35,326) |
Tramadol (n=21,672) |
| Resident characteristics | ||||
| ≥85 years | 53.0 | 48.6 | 51.1 | 57.2 |
| Women | 75.8 | 73.0 | 74.3 | 79.1 |
| Race/ethnicity | ||||
| Non-Hispanic white | 82.3 | 80.3 | 82.1 | 83.2 |
| Non-Hispanic black | 11.7 | 13.7 | 11.7 | 11.1 |
| Hispanic/Latino | 4.5 | 4.6 | 4.5 | 4.6 |
| Other | 1.5 | 1.4 | 1.7 | 1.1 |
| Medicaid dual-eligibility | 87.6 | 90.1 | 87.7 | 86.8 |
| Physical limitations2 | ||||
| Extensive assistance required | 50.7 | 52.9 | 50.5 | 50.4 |
| Physically dependent | 21.5 | 25.3 | 21.9 | 20.0 |
| Cognitive impairment3 | ||||
| Moderate | 31.5 | 31.5 | 31.5 | 31.5 |
| Severe | 39.5 | 34.4 | 40.6 | 39.2 |
| Psychopharmacologic medications4 | ||||
| Antidepressants | 62.3 | 64.9 | 63.1 | 60.4 |
| Antipsychotic | 27.5 | 24.5 | 28.3 | 26.9 |
| Antianxiety | 21.3 | 20.5 | 22.0 | 20.4 |
| Hypnotics | 6.5 | 6.7 | 6.7 | 6.1 |
| Other medications prescribed for pain4 | ||||
| Anticonvulsants | 15.5 | 19.5 | 15.7 | 13.9 |
| Corticosteroids | 7.2 | 7.8 | 7.1 | 7.1 |
| Muscle relaxants | 4.1 | 5.1 | 4.3 | 3.6 |
| Nonsteroidal anti-inflammatory drugs | 11.6 | 10.7 | 11.2 | 12.6 |
| Pain recorded on Minimum Data Set5 | ||||
| Any self-reported pain | 28.8 | 33.4 | 28.6 | 28.0 |
| Any staff-assessed pain | 4.2 | 4.6 | 4.5 | 3.6 |
| Painful comorbidities5,6 | ||||
| Any injury (excludes poisonings) | 18.3 | 22.6 | 19.0 | 15.8 |
| Pressure ulcers | 7.4 | 11.3 | 7.2 | 6.5 |
| Diagnosed chronic pain | 2.7 | 4.0 | 2.5 | 2.6 |
| Abdominal pain | 5.5 | 7.2 | 5.2 | 5.3 |
| Musculoskeletal pain | 64.0 | 67.5 | 62.6 | 65.4 |
| Neuropathic pain | 7.3 | 8.2 | 7.3 | 6.9 |
| Any emergency room use | 16.2 | 18.0 | 17.7 | 13.3 |
| Facility characteristics | ||||
| Rural location | 31.6 | 19.1 | 33.6 | 31.9 |
| ≥200 beds | 11.0 | 21.3 | 9.3 | 11.0 |
| For profit ownership | 73.1 | 68.2 | 75.0 | 71.3 |
| Part of a chain | 57.6 | 49.6 | 59.1 | 57.3 |
| <80% occupancy7 | 26.4 | 16.0 | 28.4 | 25.9 |
| ≥80% of residents have Medicaid as primary payer7 |
15.6 | 16.5 | 16.0 | 14.2 |
| <10% of facility receiving skilled nursing care7 | 35.6 | 34.3 | 37.1 | 35.6 |
| Nursing Home Compare quality rating much below average (1 star) |
9.4 | 8.0 | 10.0 | 8.7 |
| ≥5% of residents have facility-acquired bed sores7 | 19.2 | 17.4 | 19.7 | 18.8 |
| ≥5% of residents restrained7 | 20.5 | 19.8 | 21.6 | 19.1 |
| <27.3 registered nurse minutes per resident day8 | 27.9 | 17.2 | 30.1 | 28.1 |
| <0.3 physician minutes per resident day8 | 25.9 | 20.1 | 26.5 | 26.4 |
| No physician extender minutes per resident day8 | 57.5 | 51.5 | 58.6 | 57.3 |
Column percentages may not add to 100% due to rounding.
Physical limitations were defined using the Activities of Daily Living Self-Performance Hierarchy (range: 0–6) to categorize residents as requiring no to limited assistance (0–2), extensive dependence (3–4), or being physically dependent (5–6).
Cognitive impairment was defined using the Brief Interview for Mental Status (BIMS; range:0–15) when the resident could self-report and the Cognitive Performance Scale (CPS; range:0–6) otherwise: none/mild (BIMS 13–15 or CPS 0–2), moderate (BIMS 8–12 or CPS 3–4) or severe impairment (BIMS 0–7 or CPS 5–6).
Subcategories are not mutually exclusive and may add to >100%.
Derived as a 3-level variable (0: no pain documented, 1: pain documented from resident, 2: pain documented by staff) from the most recent Minimum Data Set assessment preceding opioid initiation.
Based on Part B claims from the 90 days prior to opioid initiation (see Supplementary Table 2 for further information on definitions used). The total number of Part B claims (median and interquartile range [IQR]) varied by opioid initiated: hydrocodone (8, IQR: 5–14), oxycodone (11, IQR: 6–18), tramadol (8, IQR: 5–13).
Derived from the most recent Certification and Survey Provider Enhanced Reporting resident census preceding the study period, which collects information on all residents living in the facility.
Only lowest staffing quartile shown. See Supplementary Table 3 for cutoffs of other quartiles.