- Design
- Cross-sectional analysis of trial baseline data with propensity matching
- Population
- 9,971 community-dwelling older Australians (479 opioid users)
- Primary outcome
- SF-36 health-related quality of life
- Effect
- Adjusted β −7.58 (−8.80 to −6.35)
A cross-sectional analysis of baseline data from the STAREE statin trial compared 479 community-dwelling older Australians taking prescribed opioids with 9,492 who were not.
Opioid users had much lower SF-36 quality-of-life scores before adjustment (β −14.3). After adjusting for sociodemographic, clinical and psychosocial factors, the difference shrank but remained (β −7.6, 95% CI −8.8 to −6.4). Every domain was lower, with physical functioning about 20 to 25 points lower.
The direction of the relationship cannot be determined: people in more pain and with poorer health are more likely to be prescribed opioids, and opioids may in turn reduce function. STAREE participants were relatively healthy, so the gap may be larger in frailer populations.
The practical point is that an older adult on an opioid is a flag for poor function and quality of life, and a reason to review whether the opioid is helping.
- Assess function and quality of life in older adults on opioids.
- Review whether the opioid is meeting a defined goal.
- Screen for low mood and social isolation alongside pain.
- Consider non-drug approaches to pain and function.
Why it matters
Opioids are often continued by default in older adults without checking whether life is better on them.
Don't overread it
Cross-sectional data; it cannot show opioids caused the poorer quality of life.
The statistics, in plain English
A β of −7.6 means opioid users scored about 7.6 points lower on the SF-36 after adjustment. The fall from −14.3 unadjusted shows that much of the gap reflected other differences between the groups.
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