{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,27]],"date-time":"2025-12-27T07:14:56Z","timestamp":1766819696039,"version":"build-2065373602"},"reference-count":33,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T00:00:00Z","timestamp":1743120000000},"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":[[2025,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>For patients with continued pain while receiving an initial course of a short\u2010acting opioid (SAO), clinicians may intensify the opioid regimen by escalating the SAO dose or initiating a long\u2010acting opioid (LAO). The objective of this study was to assess the comparative safety of opioid intensification regimens in nursing home residents with nonmalignant pain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort analysis of US long\u2010stay nursing home residents identified from the national Minimum Data Set (MDS) 3.0 and linked Medicare data, 2011\u20132016. Opioid regimen changes were assessed using Part D claims to identify dose escalation of SAO, adding LAO to SAO, or a switch from SAO to LAO. The outcomes of interest were hospitalized falls\/fractures and delirium identified in the MDS or hospitalization. Resident attributes were described by opioid regimen. Hazard ratios of study outcomes were quantified using as\u2010treated (primary analysis) and intent\u2010to\u2010treat (secondary analysis) doubly robust inverse probability of treatment (IPT) weighted Fine &amp; Gray regression models with a competing risk of death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the as\u2010treated analysis, relative to residents in the SAO escalation cohort, the hazard of delirium was elevated in the LAO cohorts (aHR [LAO switch]: 2.05, 95% CI: 1.57\u20132.67; aHR [LAO add\u2010on]: 1.55, 95% CI: 1.23\u20131.96). Results for falls and fractures were inconclusive. We did not observe evidence of an association with falls and fractures in the primary as\u2010treated analysis; however, the intent\u2010to\u2010treat analysis observed increased hazards in the LAO switch cohort relative to the SAO escalation cohort (aHR 2.86, 95% CI:1.64\u20134.99).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>There is limited evidence to inform the clinical judgment between escalating the SAO dose or incorporating a LAO. Our study suggests increased risks of delirium in nursing home residents with nonmalignant pain when switching or adding an LAO to the opioid regimen relative to increasing the dose of SAOs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.19417","type":"journal-article","created":{"date-parts":[[2025,3,30]],"date-time":"2025-03-30T17:35:08Z","timestamp":1743356108000},"page":"1517-1527","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Comparative Safety of Short\u2010Acting Opioid Dose Escalation and Long\u2010Acting Opioid Initiation in Nursing Home Residents"],"prefix":"10.1111","volume":"73","author":[{"given":"Anthony P.","family":"Nunes","sequence":"first","affiliation":[{"name":"Department of Population and Quantitative Health Sciences, Division of Epidemiology, UMass Chan Medical School  Worcester Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heeyoon","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Population and Quantitative Health Sciences, Division of Epidemiology, 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":"Department of Population and Quantitative Health Sciences, Division of Epidemiology, UMass Chan Medical School  Worcester Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonggyu","family":"Baek","sequence":"additional","affiliation":[{"name":"Department of Population and Quantitative Health Sciences, Division of Biostatistics and Health Services Research, 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, Memorial Hospital of Rhode Island Brown University  Providence Rhode Island USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shao\u2010Hsien","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Population and Quantitative Health Sciences, Division of Epidemiology, UMass Chan Medical School  Worcester Massachusetts 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":"Department of Population and Quantitative Health Sciences, Division of Epidemiology, UMass Chan Medical School  Worcester Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,3,28]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.18182"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2022.08.008"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2020.12.029"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00228-017-2384-2"},{"issue":"1","key":"e_1_2_9_6_1","first-page":"6","article-title":"The Use of Opioids for the Treatment of Chronic Pain. 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