{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T14:04:30Z","timestamp":1770473070556,"version":"3.49.0"},"reference-count":50,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2023,8,2]],"date-time":"2023-08-02T00:00:00Z","timestamp":1690934400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000056","name":"National Institute of Nursing Research","doi-asserted-by":"publisher","award":["R01NR016977"],"award-info":[{"award-number":["R01NR016977"]}],"id":[{"id":"10.13039\/100000056","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The comparative safety of serotonin and norepinephrine reuptake inhibitors (SNRIs) as adjuvants to short\u2010acting opioids in older adults is unknown even though SNRIs are commonly used. We compared the effects of SNRIs versus nonsteroidal anti\u2010Inflammatory drugs (NSAIDs) on delirium among nursing home residents when SNRIs or NSAIDs were added to stable regimens of short\u2010acting opioids.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Using 2011\u20132016 national Minimum Data Set (MDS) 3.0 and Medicare claims data to implement a new\u2010user design, we identified a cohort of nursing home residents receiving short\u2010acting opioids who initiated either an SNRI or an NSAID. Delirium was defined from the Confusion Assessment Method in MDS 3.0 assessments and ICD9\/10 codes using Medicare hospitalization claims. Propensity score matching balanced underlying differences for initiating treatments on 39 demographic and clinical characteristics (n\n                      <jats:sub>SNRIs<\/jats:sub>\n                      \u2009=\u20095350; n\n                      <jats:sub>NSAIDs<\/jats:sub>\n                      \u2009=\u20095350). Fine and Gray models provided hazard ratios (HRs) and 95% confidence intervals (CIs) adjusting for the competing risk of death.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Hydrocodone was the most commonly used short\u2010acting opioid (48%). Residents received ~23\u2009mg daily oral morphine equivalent at the time of SNRIs\/NSAIDs initiation. The majority were women, non\u2010Hispanic White, and aged \u226575\u2009years. There were no differences in any of the confounders after propensity matching. Over 1 year, 10.8% of SNRIs initiators and 8.9% of NSAIDs initiators developed delirium. The rate of delirium onset was similar in SNRIs and NSAID initiators (HR(delirium in nursing home or hospitalization for delirium):1.10; 95% CI: 0.97\u20131.24; HR(hospitalization for delirium): 1.06; 95% CI: 0.89\u20131.25), and were similar regardless of baseline opioid daily dosage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among nursing home residents, adding SNRIs to short\u2010acting opioids does not appear to increase risk of delirium relative to initiating NSAIDs. Understanding the comparative safety of pain regimens is needed to inform clinical decisions in a medically complex population often excluded from clinical research.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.18519","type":"journal-article","created":{"date-parts":[[2023,8,2]],"date-time":"2023-08-02T09:13:58Z","timestamp":1690967638000},"page":"3390-3402","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Comparative safety of adding serotonin and norepinephrine reuptake inhibitors (\n                    <scp>SNRIs)<\/scp>\n                    versus nonsteroidal anti\u2010inflammatory drugs (\n                    <scp>NSAIDs)<\/scp>\n                    to short\u2010acting opioids for non\u2010malignant pain in nursing homes"],"prefix":"10.1111","volume":"71","author":[{"given":"Shao\u2010Hsien","family":"Liu","sequence":"first","affiliation":[{"name":"Division of Epidemiology, Department of Population and Quantitative Health Sciences UMass Chan Medical School  Worcester Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8322-5648","authenticated-orcid":false,"given":"Yiyang","family":"Yuan","sequence":"additional","affiliation":[{"name":"Division of Epidemiology, Department of Population and Quantitative Health Sciences UMass Chan Medical School  Worcester Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonggyu","family":"Baek","sequence":"additional","affiliation":[{"name":"Division of Biostatistics and Health Services Research, Department of Population and Quantitative Health Sciences UMass Chan Medical School  Worcester Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony P.","family":"Nunes","sequence":"additional","affiliation":[{"name":"Division of Epidemiology, Department of Population and Quantitative Health Sciences UMass Chan Medical School  Worcester Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jayne","family":"Pawasauskas","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, College of Pharmacy University of Rhode Island  Kingston Rhode Island USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne L.","family":"Hume","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, College of Pharmacy University of Rhode Island  Kingston Rhode Island USA"},{"name":"Department of Family Medicine, Alpert Medical School Brown University, Memorial Hospital of Rhode Island  Providence Rhode Island USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9957-7747","authenticated-orcid":false,"given":"Kate L.","family":"Lapane","sequence":"additional","affiliation":[{"name":"Division of Epidemiology, Department of Population and Quantitative Health Sciences UMass Chan Medical School  Worcester Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,8,2]]},"reference":[{"issue":"37","key":"e_1_2_11_2_1","first-page":"1","article-title":"Long\u2010term Care Services in the United States: 2013 overview","volume":"3","author":"Harris\u2010Kojetin L","year":"2013","journal-title":"Vital Health Stat"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000000887"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1532\u20105415.50.6s.1.x"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmn.2011.10.006"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.2165\/00002512\u2010199101050\u201000006"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40266\u2010021\u201000836\u20108"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00228\u2010020\u201002878\u20100"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304\u20103959(92)90144\u2010Z"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102016\u2010011200"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.3238\/arztebl.2016.0855"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.2147\/TCRM.S176079"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afq140"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.2003.017236"},{"key":"e_1_2_11_15_1","unstructured":"U.S. Centers for Medicare and Medicaid Services.MDS 3.0 RAI Manual. Published online 2017. Accessed July 12 2017.https:\/\/www.cms.gov\/Medicare\/Quality-Initiatives-Patient-Assessment-Instruments\/NursingHomeQualityInits\/MDS30RAIManual.html"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2012.06.001"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/54.11.M546"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000334"},{"key":"e_1_2_11_19_1","unstructured":"Oncology NCPG in.NCCN Clinical Practice Guidelines in Oncology: Adult Cancer Pain. Accessed April 10 2018.https:\/\/www.nccn.org\/professionals\/physician_gls\/default.aspx"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mds233"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.15080"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwg231"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s001250051477"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.2174\/157015909790031201"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532\u20105415.2007.01239.x"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.1182"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glp215"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2016.10.369"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.6004"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.3697"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwp107"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1007\/978\u20101\u20104613\u20102509\u20103_16"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/pst.433"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare10081544"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/gps.3814"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2013.06.004"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/pon.4140"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102702.2012.04130.x"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525\u20101497.1998.00073.x"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532\u20105415.2006.00815.x"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12877\u2010018\u20100733\u20103"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.17662"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2007.4"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40264\u2010021\u201001136\u20101"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40266\u2010018\u20100583\u2010x"},{"key":"e_1_2_11_46_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.49950"},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2008.05.026"},{"key":"e_1_2_11_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2021.04.016"},{"key":"e_1_2_11_49_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532\u20105415.2009.02376.x"},{"key":"e_1_2_11_50_1","doi-asserted-by":"publisher","DOI":"10.1177\/2049463720976155"},{"key":"e_1_2_11_51_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2020.04.029"}],"container-title":["Journal of the American Geriatrics Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jgs.18519","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T15:02:26Z","timestamp":1762182146000},"score":1,"resource":{"primary":{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/10.1111\/jgs.18519"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,2]]},"references-count":50,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2023,11]]}},"alternative-id":["10.1111\/jgs.18519"],"URL":"https:\/\/doi.org\/10.1111\/jgs.18519","archive":["Portico"],"relation":{},"ISSN":["0002-8614","1532-5415"],"issn-type":[{"value":"0002-8614","type":"print"},{"value":"1532-5415","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,2]]},"assertion":[{"value":"2023-02-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-06-19","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-08-02","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}