Kinless Older Adults With Dementia: Qualitative Analysis of Data From the Adult Changes in Thought Study.

Objectives: To examine the circumstances and needs of older adults who were "kinless," defined as having no living spouse or children, when they developed dementia.

Methods: We conducted a secondary analysis of information from the Adult Changes in Thought study. Among 848 participants diagnosed with dementia between 1994 and 2016, we identified 64 who had no living spouse or child at dementia onset.

Sex Differences in Comorbid Mental and Substance Use Disorders Among Primary Care Patients With Opioid Use Disorder.

Objective: The authors sought to characterize the 3-year prevalence of mental disorders and nonnicotine substance use disorders among male and female primary care patients with documented opioid use disorder across large U.S. health systems.

ISI-3: evaluation of a brief screening tool for insomnia.

Study Objectives: We evaluated the performance of the Insomnia Severity Index-3 (ISI-3) as a short screening tool to identify clinically significant insomnia derived from the 7-item ISI in an older primary care population.

Methods: We used results from two surveys including the 7-item ISI: Sample 1 (n = 3197) and Sample 2 (n = 247) individuals aged ≥60 years with a diagnosis of osteoarthritis from electronic health records. The 7 items were: difficulty falling asleep, difficulty staying asleep, waking too early, sleep satisfaction, sleep interference with daytime functioning, noticeability of sleep problems by others, and worry about sleep.

Effect of Changing Electronic Health Record Opioid Analgesic Dispense Quantity Defaults on the Quantity Prescribed: A Cluster Randomized Clinical Trial.

Importance: Interventions to improve judicious prescribing of opioid analgesics for acute pain are needed owing to the risks of diversion, misuse, and overdose.

Objective: To assess the effect of modifying opioid analgesic prescribing defaults in the electronic health record (EHR) on prescribing and health service use.

Design, Setting, And Participants: A cluster randomized clinical trial with 2 parallel arms was conducted between June 13, 2016, and June 13, 2018, in a large urban health care system comprising 32 primary care and 4 emergency department (ED) sites in the Bronx, New York.

Effect of Telephone Cognitive Behavioral Therapy for Insomnia in Older Adults With Osteoarthritis Pain: A Randomized Clinical Trial.

Importance: Scalable delivery models of cognitive behavioral therapy for insomnia (CBT-I), an effective treatment, are needed for widespread implementation, particularly in rural and underserved populations lacking ready access to insomnia treatment.

Objective: To evaluate the effectiveness of telephone CBT-I vs education-only control (EOC) in older adults with moderate to severe osteoarthritis pain.

Design, Setting, And Participants: This is a randomized clinical trial of 327 participants 60 years and older who were recruited statewide through Kaiser Permanente Washington from September 2016 to December 2018.

Prevalence and Medication Treatment of Opioid Use Disorder Among Primary Care Patients with Hepatitis C and HIV.

Background: Hepatitis C and HIV are associated with opioid use disorders (OUD) and injection drug use. Medications for OUD can prevent the spread of HCV and HIV.

Objective: To describe the prevalence of documented OUD, as well as receipt of office-based medication treatment, among primary care patients with HCV or HIV.

Changes in dysfunctional beliefs about sleep after cognitive behavioral therapy for insomnia: A systematic literature review and meta-analysis.

Cognitive behavioral therapy for insomnia (CBT-I) is the preferred treatment for chronic insomnia and sleep-related cognitions are one target of treatment. There has been little systematic investigation of how sleep-related cognitions are being assessed in CBT-I trials and no meta-analysis of the impact of CBT-I on dysfunctional beliefs about sleep, a core cognitive component of treatment. Academic Search Complete, Medline, CINAHL and PsychInfo from 1990 to 2018 were searched to identify randomized controlled trials of CBT-I in adults (≥18 years) reporting some measure of sleep-related cognitions.

Telephone interventions for co-morbid insomnia and osteoarthritis pain: The OsteoArthritis and Therapy for Sleep (OATS) randomized trial design.

The OsteoArthritis and Therapy for Sleep (OATS) study is a population-based randomized controlled trial of cognitive behavioral therapy for insomnia (CBTI) with four innovative methodological aims. These are to: (1) Enroll representative participants across Washington state, including those from medically underserved communities; (2) Enroll persons with persistent insomnia and chronic osteoarthritis (OA) pain; (3) Test a scalable CBT-I intervention; and (4) Evaluate patient-reported outcomes (insomnia, pain severity, fatigue, depression) and cost-effectiveness over one year. This paper describes progress towards achieving these aims.

Impact of initiatives to reduce prescription opioid risks on medically attended injuries in people using chronic opioid therapy.

Purpose: The purpose of the study is to determine whether initiatives to improve the safety of opioid prescribing decreased injuries in people using chronic opioid therapy (COT).

Methods: We conducted an interrupted time series analysis using data from Group Health (GH), an integrated health care delivery system in the United States. In 2007, GH implemented initiatives which substantially reduced daily opioid dose and increased patient monitoring.

Sex/gender disparities in health outcomes of individuals with long-term disabling conditions.

Background: Women with disabling conditions experience health disparities relative to nondisabled women, but few studies have compared women and men with disabling conditions.

Objectives: To investigate gender differences in physical functioning and emotional health among individuals with long-term disabling conditions, that is, neuromuscular disease, multiple sclerosis, postpolio syndrome, or spinal cord injury.

Method: From a mailed survey of 1,862 adults with long-term disabling conditions, we used the 12-item Patient-Reported Outcomes Measurement Information System (PROMIS) physical functioning to assess physical limitations in activities and Patient Health Questionnaire-9 (PHQ-9) for emotional health and severity of secondary conditions (rated 0-10).

Impact of Chronic Opioid Therapy Risk Reduction Initiatives on Opioid Overdose.

We assessed the effects of opioid dose and risk reduction initiatives on opioid overdose rates among patients on chronic opioid therapy (COT). Using an interrupted time series design, we compared trends in overdose rates. We compared patients on COT in settings that implemented a COT dose reduction initiative and then a COT risk stratification/monitoring initiative to similar patients on COT from control settings.

Doctor-Patient Trust Among Chronic Pain Patients on Chronic Opioid Therapy after Opioid Risk Reduction Initiatives: A Survey.

Objective: This analysis examined patients' perceptions about trust within the doctor-patient relationship related to managing opioid pain medications. We compared perceptions among chronic opioid therapy (COT) patients who were and were not exposed to opioid risk reduction initiatives.

Methods: Between 2014 and 2016, we surveyed 1588 adults with chronic pain receiving COT about their trust in their prescribing doctor, their perceptions of their doctor's trust in them, their concerns about opioid prescribing, and their knowledge of opioid safety concerns.

Persistent Pain Quality as a Novel Approach to Assessing Risk for Disability in Community-Dwelling Elders With Chronic Pain.

Background: This study aims to test whether persistent pain quality is associated with incident or worsening disability in four domains: mobility, activity of daily living (ADL) and instrumental activity of daily living (IADL) difficulty, and physical performance.

Methods: From the MOBILIZE Boston Study, a population-based cohort of adults aged ≥70 years, we studied participants with chronic pain who endorsed at least one pain quality descriptor (N = 398) and completed baseline and 18-month assessments. Pain quality was assessed using an adapted short-form McGill Pain Questionnaire with 20 pain quality descriptors in three categories: sensory, cognitive/affective, neuropathic.

Persistence of pain quality in community-dwelling older adults with chronic non-cancer pain.

Longitudinal assessment of chronic geriatric pain is complicated by an age-associated plateau in pain severity and increase in widespread pain, calling for innovative measures such as pain quality descriptors that characterize how pain may feel. We characterized persistence of pain quality and its relation to severity, activity interference and distribution of sites, in a population-based sample of adults aged≥70 years with chronic pain (n = 398). Persistent pain quality was defined as reporting descriptors within the same category: sensory, cognitive/affective, or neuropathic at baseline and 18 months.

Impact of Opioid Dose Reduction and Risk Mitigation Initiatives on Chronic Opioid Therapy Patients at Higher Risk for Opioid-Related Adverse Outcomes.

Objective: We aimed to determine if opioid risk reduction initiatives including dose reduction and risk mitigation strategies for chronic noncancer pain patients receiving chronic opioid therapy (COT) had a differential impact on average daily opioid doses of COT patients at higher risk for opioid-related adverse outcomes compared with lower-risk patients.

Design: Interrupted time series.

Setting: Group Health Cooperative (GH), a health care delivery system and insurance within Washington State, between 2006 and 2014.

Comparing Pain and Depressive Symptoms of Chronic Opioid Therapy Patients Receiving Dose Reduction and Risk Mitigation Initiatives With Usual Care.

Unlabelled: Dose reduction and risk mitigation initiatives have been recommended to reduce opioid-related risks among patients receiving chronic opioid therapy (COT), but questions remain over whether these initiatives worsen pain control and quality of life. In 2014 to 2015, we interviewed 1,588 adult COT patients within a health care system in Washington State and compared those who received dose reduction and risk mitigation initiatives in primary care clinics (intervention) with patients in comparable health care settings without initiatives (control). The primary outcomes were pain assessed using the pain, enjoyment, and general activity (PEG) scale, a 3-item scale to assess global pain intensity and interference, with secondary measures including depression (Patient Health Questionnaire-8 scale).

Prevalence of prescription opioid use disorder among chronic opioid therapy patients after health plan opioid dose and risk reduction initiatives.

Background: No studies have assessed the comparative effectiveness of guideline-recommended interventions to reduce risk of prescription opioid use disorder among chronic opioid therapy (COT) patients. We compared the prevalence of prescription opioid use disorder among COT patients from intervention clinics that had implemented opioid dose and risk reduction initiatives for more than 4 years relative to control clinics that had not.

Methods: After a healthcare system in Washington State implemented interventions to reduce opioid dose and risks, we surveyed 1588 adult primary care COT patients to compare the prevalence of prescription opioid use disorder among COT patients from the intervention and control clinics.

A longitudinal study of depression among middle-aged and senior patients initiating chronic opioid therapy.

Background: Improved understanding how depressive symptoms change with sustained opioid use is needed.

Methods: We prospectively assessed patients 45 years or older initiating chronic opioid therapy (COT) at baseline and at 4 and 12 months, differentiating recent COT initiators (n=748) and continuing users (n=468). Level of opioid use before 12-month follow-up was classified as regular/higher-dose, intermittent/lower-dose, or minimal/no use.

Pain quality descriptors in community-dwelling older adults with nonmalignant pain.

This study aimed to characterize the prevalence of various pain qualities in older adults with chronic nonmalignant pain and determine the association of pain quality to other pain characteristics namely: severity, interference, distribution, and pain-associated conditions. In the population-based MOBILIZE Boston Study, 560 participants aged ≥70 years reported chronic pain in the baseline assessment, which included a home interview and clinic exam. Pain quality was assessed using a modified version of the McGill Pain Questionnaire (MPQ) consisting of 20 descriptors from which 3 categories were derived: cognitive/affective, sensory, and neuropathic.

A stiff price to pay: does joint stiffness predict disability in an older population?

Objectives: To describe the prevalence of joint stiffness and associated comorbidities in community-living older adults and to determine whether joint stiffness, independent of pain, contributes to new and worsening disability.

Design: Population-based cohort.

Setting: Urban and suburban communities in the Boston, Massachusetts, area.