Primary care providers' perspective on prescribing opioids to older adults with chronic non-cancer pain: A qualitative study

<p>Abstract</p> <p>Background</p> <p>The use of opioid medications as treatment for chronic non-cancer pain remains controversial. Little information is currently available regarding healthcare providers' attitudes and beliefs about this practice among older adults. This study aimed to describe primary care providers' experiences and attitudes towards, as well as perceived barriers and facilitators to prescribing opioids as a treatment for chronic pain among older adults.</p> <p>Methods</p> <p>Six focus groups were conducted with a total of 23 physicians and three nurse practitioners from two academically affiliated primary care practices and three community health centers located in New York City. Focus groups were audiotape recorded and transcribed. The data were analyzed using directed content analysis; NVivo software was used to assist in the quantification of identified themes.</p> <p>Results</p> <p>Most participants (96%) employed opioids as therapy for some of their older patients with chronic pain, although not as first-line therapy. Providers cited multiple barriers, including fear of causing harm, the subjectivity of pain, lack of education, problems converting between opioids, and stigma. New barriers included patient/family member reluctance to try an opioid and concerns about opioid abuse by family members/caregivers. Studies confirming treatment benefit, validated tools for assessing risk and/or dosing for comorbidities, improved conversion methods, patient education, and peer support could facilitate opioid prescribing. Participants voiced greater comfort using opioids in the setting of delivering palliative or hospice care versus care of patients with chronic pain, and expressed substantial frustration managing chronic pain.</p> <p>Conclusions</p> <p>Providers perceive multiple barriers to prescribing opioids to older adults with chronic pain, and use these medications cautiously. Establishing the long-term safety and efficacy of these medications, generating improved prescribing methods, and implementing provider and patient educational interventions could help to improve the management of chronic pain in later life.</p

Environmental Disparities in the Objectively and Longitudinally Measured Local Food Environments of Urban Older Adults

Background: Valid measures of local food environments are needed to quantify disparities in the availability of healthy foods and estimate the effect of built environments on health. Limited measures are available to describe the fluctuation of food retail environments over time, and how food environments are utilized by older adults. Purpose: This study measured neighborhood environments of older adults living in Brooklyn, NY, using an objective, prospective audit tool in order to document variations in the availability of food retailers and other neighborhood resources over a two-year period. Additionally, neighborhood utilization patterns, which may mitigate exposure to the built environment, were assessed using surveys of participating older adults. Methods: Older adults enrolled in the Cardiovascular Health of Seniors and the Built Environment study in New York City (NYC) between 2009-2011 completed surveys in person at baseline and two years later (n=1,318). Auditors documented food retailers located on NYC streets within 300-meters of each participant’s home, within six months of baseline surveys, and two years later. Results: Most participants walked to food stores, purchased food less than 0.5 mile from home, and consumed meals at home. Changes to food retail environments were observed by race and ethnicity, with decreases in bodegas (b= -1.28, standard error (SE) = 0.18) and liquor stores (b= -0.19, SE 0.05) in the buffer zones of white participants compared with that of black participants. Increases in supermarkets were observed in both white (b= 0.27, SE 0.07) and Latino buffer zones (b= 0.28, SE 0.08). Conclusions: Changes in food environments varied by areas where Black, White, and Hispanic participants lived. Understanding the variation of exposure to local food environments over time, and how the exposures may be mediated by behaviors, will lead to more precision in exposure assignment within this area of environmental and health science

Neighborhood Environment and Adiposity among Older Adults: the Cardiovascular Health of Seniors and the Built Environment Study

Background. Individual neighborhood factors are associated with obesity-related health behaviors and rates; however, there remains a paucity of information characterizing whole environments in these relationships and limited information on the effect for older adults. Methods. Adults, aged 60 or older living in New York City, were enrolled into the Cardiovascular Health of Seniors and the Built Environment between January 2009 and June 2011. Walking audits of all streets within 300-meter buffer zones around residential addresses were conducted resulting in the assessment of 34 different neighborhood features hypothesized to be associated with obesity through physical activity and diet. Outcomes included objective measures of body fat mass (FM), waist circumference (WC), and body mass index (BMI). Stratified linear regression models were used to calculate geographic differences in associations between neighborhood resources and adiposity by gender and age categories in areas where Black, White and Latino residents lived. Results. For women 60-69 years of age living in black areas, neighborhood features resulted in a higher FM than the average Brooklyn neighborhood (Difference (D) =2.15, 95% CI [1.15, 3.15]). Conversely, for women of the same age living in white and Latino areas, a lower prevalence of FM was observed: white areas: (D= -2.01, 95% CI [-3.62, -0.40]); Latino areas: (D= -1.43, 95% CI [-2.72, -0.14]). The direction of the effects remained similar for other age groups, although the estimates were less precise. Estimates of FM were inconsistent across age groups for men living in each of the areas. Other measurements of adiposity showed similar results. Conclusions. The composition of neighborhood features in white and Latino residential areas is protective of adiposity, whereas features located in black areas appear to place residents at greater risk