Longitudinal Pain Medication Use Among US Older Adults After a Hip Fracture

To describe longitudinal pain medication use, including gabapentinoid-opioid co-prescribing, among older adults discharged to a skilled nursing facility (SNF) following a hip fracture.

Retrospective cohort study using Medicare claims linked to medication dispensing records from a large commercial SNF pharmacy.

Older Medicare fee-for-service beneficiaries hospitalized for a hip fracture between 2012 and 2018 who were discharged to an SNF.

We followed beneficiaries from the first day in an SNF up to 100 days to describe opioid, nonopioid analgesic, and gabapentinoid medication regimens dispensed overall and stratified by time since SNF admission, race/ethnicity, and sex.

We identified 88,433 eligible and matched individuals [average age at SNF entry = 84.8 (SD = 8.05) years, 76.7% female]. Of these, 83.7% received any pain medication in the 100 days after SNF admission. The most prevalent pain medication regimen was hydrocodone plus acetaminophen (16.7% prevalence overall), followed by oxycodone plus acetaminophen (11.2%). Dispensing of most medication regimens, particularly opioid-based regimens, declined by more than 50% by day 30 after SNF admission, with oxycodone-based regimens declining more so than hydrocodone-based ones. However, by days 60 to 100, an increase in use of several opioid-based regimens was observed. Among the 6671 individuals prescribed a gabapentinoid in the first 15 days after hospitalization, 91% were co-prescribed an opioid regardless of prior gabapentinoid use before the hip fracture. Prevalence of any pain medication dispensing was similar between sexes and race/ethnicity subgroups, but medication regimens differed by race/ethnicity.

Most older adults received pain medication after hip fracture, and multimodal opioid-containing regimens were most common. Most individuals who received a gabapentinoid immediately after SNF admission were co-prescribed an opioid. These findings suggest a need for closer medication management in SNFs to ensure adequate pain control after hip fracture while minimizing potentially harmful analgesic combinations.