(C-053) Opioid Tapering and Functional Status among Older Adults on Long-Term Opioid Therapy Receiving Home Health Care

Tuesday, August 26, 2025

12:00 PM - 1:30 PM ET

Presenting Author(s)

Nga Weng Leong

Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA, United States

Co-Author(s)

AA

Arman Arabshomali

Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA, United States
KB

Kaustuv Bhattacharya

Department of Pharmacy Administration and Center for Pharmaceutical Marketing & Management, School of Pharmacy, University of Mississippi, University, MS, USA, United States
SM

Shishir Maharjan

Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA, United States
JB

John P. Bentley

Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA, United States
SR

Sujith Ramachandran

Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA, United States
YH

Yinan Huang, PhD, MS

Assistant Professor
Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA
University, Mississippi, United States
IE

Ike Eriator

University of Mississippi Medical Center, United States
YY

Yi Yang

Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA, United States

Background: Opioid use has been shown to improve functional status among older adults during home health (HH) care. However, abrupt opioid dose reduction may be associated with adverse health outcomes. It remains unclear how opioid tapering affects functional status among older adults on long-term opioid therapy (LTOT) who received HH care.

Objectives: To evaluate the association between the rate of opioid tapering and worsening of functional status among Medicare-enrolled older LTOT users receiving HH care.

Methods: A nested case-control study was conducted using 5% Medicare administrative claims data (2012–2020) linked with the Outcome and Assessment Information Set (OASIS) data. The study cohort included adults ≥ 65 who were on LTOT for at least 90 days before HH admission (cohort entry). Those with prior HH, hospice use, or cancer history were excluded. Change in functional status was measured by the difference in the composite score of activities of daily living (ADL) between cohort entry and the last available ADL assessment (index date) during the same HH stay. Those with the two ADL assessments within 30 days were excluded. Individuals experiencing ADL worsening were defined as cases. For each case, 1-2 controls (no ADL worsening) were selected and matched based on time between assessments and HH referral source using risk set sampling. The rate of opioid dose changes was estimated over a 120-day window before the index date and was categorized into steady dose, slow tapering, rapid tapering, and dose escalation. Covariates included sociodemographic and clinical factors, such as surgery before HH admission, average baseline opioid dose, use of non-pharmacological pain treatment, and other psychotropic medications. Conditional logistic regression was used to assess the relationship between the rate of opioid dose changes and ADL worsening.

Results: A total of 815 individuals met the inclusion criteria. Most were female (79.26%), aged 65-79 (65.28%), White (74.48%), and referred from community (52.02%). Among 274 cases, 68.25% were on steady dose, 14.23% experienced dose escalation, 11.68% had slow tapering, and 5.84% had rapid tapering. After adjusting for covariates, when compared to steady dose, there was no increased odds of ADL worsening for opioid slow tapering (aOR=0.98, 95%CI:0.61-1.59) and dose escalation (aOR=1.39, 95%CI:0.87-2.22). However, the odds of ADL worsening among those with rapid tapering were 2.39 times the odds as those on steady dose (aOR=2.39, 95%CI:1.13-5.04).

Conclusions: Findings from this study suggest that rapid opioid tapering was associated with worsening of functional status in older LTOT users receiving HH care. Clinicians should exercise caution when making opioid dose changes in this vulnerable population.