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Published on: April 14, 2016
Loneliness and Initiation of Potentially Inappropriate Pain and Psychotropic Medications: A Retrospective Cohort
Rachel D Savage1,2,3,4, Susan E Bronskill5,6,7,8, Andrea Gruneir9
1Women's Age Lab, Women's College Hospital, 76 Grenville Street, 6th Floor, Toronto, ON, M5S 1B2, Canada. rachel.savage@wchospital.ca.
Background:
Loneliness is associated with high-risk medication use in older adults in cross-sectional studies, but the direction of this relationship is unclear.
Objective:
The aim of this study was to examine the association between loneliness and initiation of potentially inappropriate pain and psychotropic medications, and test for sex interactions.
Methods:
We conducted a retrospective cohort study of community-dwelling respondents to the Canadian Community Health Survey-Healthy Aging who were interviewed between December 1, 2008, and November 30, 2009, aged ≥66 years, and Ontario residents. Self-reported loneliness was defined at baseline as a score of ≥6 on the Three-Item Loneliness Scale. Survey responses were linked to health records; respondents were followed for 3 years to assess initiation of a potentially inappropriate pain or psychotropic medication, defined using the 2019 American Geriatrics Society's Beers Criteria. We used weighted Cox proportional hazards regression models to estimate adjusted hazard ratios (HRs) and tested for sex interactions.
Results:
Of 2348 respondents (female 54.6%, mean age 75.4 years), 383 (12.3%) were lonely. Compared with those who were not lonely, lonely female respondents had higher rates of initiating potentially inappropriate pain medications (HR at 90 days: 1.57, 95% CI 0.96-2.27; 630 days: 1.52, 95% CI 1.05-2.12; 1080 days: 3.22, 95% CI 1.22-7.78) and potentially inappropriate psychotropic medications, but the latter estimates were imprecise. No association was found in males.
Conclusion:
Lonely older females initiate potentially inappropriate pain and psychotropic medications at higher rates than those who are not lonely. Screening for loneliness could prioritize patients for medication reviews, possible deprescribing, and interventions that address root causes.
