Pain treatments after hip fracture among older nursing home residents
Open accessAbstract
Objectives To examine the association between use of opioids versus other analgesics with death and functioning after hip fracture in older nursing home (NH) residents. Design Retrospective cohort using national Medicare fee-for-service claims linked to the Minimum Data Set. Setting U.S. NHs. Participants NH residents aged ≥65 years who became a long-stay resident (>100 days in the NH) between January 2008 and December 2009, had a hospitalized hip fracture, and returned to the NH. Exposure New use of opioid versus non-opioid analgesics (acetaminophen or non-steroidal anti-inflammatory drugs) within 14 days post-hip fracture. Measurements Follow up began on the index date and continued until the first occurrence of death, significant functional decline (3-point increase on MDS Activities of Daily Living scale), or 120 days of follow-up. Odds ratios (ORs) with 95% confidence intervals (CIs) for outcomes were estimated using inverse-probability-of-treatment-weighted multinomial logistic regression models. Results Among the 2,755 NH residents with a hip fracture included in our study, 1,155 (41.9%) were opioid users and 1,600 (58.1%) were non-opioid analgesic users. The mean age was 86.3 years, 73.8% were female, and 86.0% were white race. Opioid use was associated with a significantly lower likelihood of death (OR=0.47, 95% CI 0.39–0.56) and a non-significant decrease in functional decline (OR=0.77, 95% CI 0.58–1.03). Conclusion A rigorous study that addresses the limitations of this study is critical to validate our preliminary findings and provide evidence about the effect of using opioid versus non-opioid analgesics to optimize acute pain in NH residents with a hip fracture.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In older nursing home residents, opioid use in the immediate 14-day period post-hip fracture was associated with a lower likelihood of death and functional decline.
“Of interest, a study assessing opioid use in the immediate 14-day period post-hip fracture in older nursing home residents found that opioid use in that period was associated with a lower likelihood of death and functional decline (234).”
From Exogenous Opioids and the Human Endocrine System: An Endocrine Society Scientific Statement (2024) · cites this paper as [234]
The Methods describe opioid use within 14 days after hip fracture in older nursing home residents. The Results report a significantly lower likelihood of death, but the lower estimate for functional decline was not statistically significant after adjustment. The claim omits that uncertainty. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
The central role of the propensity score in observational studies for causal effects
ROSENBAUM, P. R., & RUBIN, D. B. (1983) · Biometrika · doi:10.1093/biomet/70.1.41 · Cited by 31,241 · see citing works
Marginal Structural Models and Causal Inference in Epidemiology
Robins, J. M., Hernán, M. Á., & Brumback, B. (2000) · Epidemiology · doi:10.1097/00001648-200009000-00011 · Cited by 5,581 · see citing works
Morris, J. N., Fries, B. E., & Morris, S. A. (1999) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/54.11.m546 · Cited by 1,408 · see citing works
Morrison, R. S., Magaziner, J., Gilbert, M., Koval, K. J., McLaughlin, M. A., Orosz, G., Strauss, E., & Siu, A. L. (2003) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/58.1.m76 · Cited by 783 · see citing works
The impact of post-operative pain on outcomes following hip fracture
Morrison, S. R., Magaziner, J., McLaughlin, M. A., Orosz, G., Silberzweig, S. B., Koval, K. J., & Siu, A. L. (2003) · Pain · doi:10.1016/s0304-3959(02)00458-x · Cited by 616 · see citing works
Immortal time bias in observational studies of drug effects
Suissa, S. (2007) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.1357 · Cited by 593 · see citing works
Postoperative Delirium: The Importance of Pain and Pain Management
Vaurio, L., Sands, L. P., Wang, Y., Mullen, E., & Leung, J. M. (2006) · Anesthesia & Analgesia · doi:10.1213/01.ane.0000199156.59226.af · Cited by 440 · see citing works
Estimating Exposure Effects by Modelling the Expectation of Exposure Conditional on Confounders
Robins, J. M., Mark, S. D., & Newey, W. K. (1992) · Biometrics · doi:10.2307/2532304 · Cited by 384 · see citing works
Age as a risk factor for inadequate emergency department analgesia
Jones, J. S., Johnson, K. E. E., & McNinch, M. (1996) · The American Journal of Emergency Medicine · doi:10.1016/s0735-6757(96)90123-0 · Cited by 195 · see citing works
Making the Investment Count: Revision of the Minimum Data Set for Nursing Homes, MDS 3.0
Saliba, D., & Buchanan, J. L. (2012) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2012.06.002 · Cited by 187 · see citing works
Overview of Significant Changes in the Minimum Data Set for Nursing Homes Version 3.0
Saliba, D., Jones, M., Streim, J. E., Ouslander, J. G., Berlowitz, D. R., & Buchanan, J. L. (2012) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2012.06.001 · Cited by 152 · see citing works
Platts‐Mills, T. F., Esserman, D. A., Brown, D. L., Bortsov, A. V., Sloane, P. D., & McLean, S. A. (2011) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2011.09.014 · Cited by 140 · see citing works
Patterns of analgesia for fractured neck of femur in Australian emergency departments
Holdgate, A., Shepherd, S., & Huckson, S. (2009) · Emergency Medicine Australasia · doi:10.1111/j.1742-6723.2009.01246.x · Cited by 76 · see citing works
Incidence of Hip Fracture in U.S. Nursing Homes
Berry, S. D., Lee, Y., Zullo, A. R., Kiel, D. P., Dosa, D. M., & Mor, V. (2016) · The Journals of Gerontology Series A · doi:10.1093/gerona/glw034 · Cited by 59 · see citing works
Self-citationFracture Risk Assessment in Long-term Care (FRAiL): Development and Validation of a Prediction Model
Berry, S. D., Zullo, A. R., Lee, Y., Mor, V., McConeghy, K. W., Banerjee, G., D’Agostino, R. B., Daiello, L. A., Dosa, D. M., & Kiel, D. P. (2017) · The Journals of Gerontology Series A · doi:10.1093/gerona/glx147 · Cited by 59 · see citing works
Self-citationGeographic Variation in Hip Fracture Among United States Long-Stay Nursing Home Residents
Banerjee, G., Zullo, A. R., Berry, S. D., Lee, Y., McConeghy, K. W., Kiel, D. P., & Mor, V. (2016) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2016.06.012 · Cited by 12 · see citing works
Self-citationClinical Update on Nursing Home Medicine: 2013
Messinger‐Rapport, B. J., Gammack, J. K., Thomas, D. R., & Morley, J. E. (2013) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2013.09.015 · Cited by 9 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Li, S., Han, X., Liu, N., Chang, J., Liu, G., & Hu, S. (2024) · Frontiers in Immunology · doi:10.3389/fimmu.2023.1285442 · Cited by 43 · see citing works
Omissions of Care in Nursing Home Settings: A Narrative Review
Ogletree, A. M., Mangrum, R., Harris, Y., Gifford, D. R., Barry, R., Bergofsky, L., & Perfetto, D. (2020) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2020.02.016 · Cited by 34 · see citing works
Disparities in Acute Pain Treatment by Cognitive Status in Older Adults With Hip Fracture
Chang, A. K., Edwards, R. R., Morrison, R. S., Argoff, C. E., Ata, A., Holt, C., & Bijur, P. E. (2019) · The Journals of Gerontology Series A · doi:10.1093/gerona/glz216 · Cited by 28 · see citing works
Exogenous Opioids and the Human Endocrine System: An Endocrine Society Scientific Statement
Karavitaki, N., Bettinger, J. J., Biermasz, N., Christ-Crain, M., Gadelha, M. R., Inder, W. J., Tsourdi, E., Wakeman, S. E., & Zatelli, M. (2024) · Endocrine Reviews · doi:10.1210/endrev/bnae023 · Cited by 14 · see citing works
Utilization by Long-Term Nursing Home Residents Under Accountable Care Organizations
Chang, C., Mainor, A. J., Colla, C. H., & Bynum, J. (2020) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2020.05.055 · Cited by 15 · see citing works
Post-Acute Care Setting After Hip Fracture Hospitalization and Subsequent Opioid Use in Older Adults
Cupp, M. A., Beaudoin, F. L., Hayes, K. N., Riester, M. R., Berry, S. D., Joshi, R., & Zullo, A. R. (2023) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2023.03.012 · Cited by 10 · see citing works
Self-citationInclusion of Nursing Homes and Long-term Residents in Medicare ACOs
Chang, C., Mainor, A. J., Raymond, S., Peck, K. A., Colla, C. H., & Bynum, J. (2019) · Medical Care · doi:10.1097/mlr.0000000000001223 · Cited by 10 · see citing works
Liu, Y., Zhou, L., & Wang, X. (2025) · Orthopaedic Surgery · doi:10.1111/os.70090 · Cited by 5 · see citing works
Zullo, A. R., Riester, M. R., Hayes, K. N., Zhang, Y., Berry, S. D., Bélanger, E., Cupp, M. A., & Beaudoin, F. L. (2024) · BMC Geriatrics · doi:10.1186/s12877-024-05486-0 · Cited by 2 · see citing works
Self-citationXiao, T., Chen, F., & Wan, Z. (2021) · PubMed Central · Cited by 1 · see citing works
Riester, M. R., Zhang, Y., Hayes, K. N., Beaudoin, F. L., & Zullo, A. R. (2024) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.5846 · Cited by 1 · see citing works
Self-citationMathur, N., Day, H. D., & Lau‐Ng, R. (2025) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2025.105679
- Authors
- Zullo, A. R., Zhang, T., Beaudoin, F. L., Lee, Y., McConeghy, K. W., Kiel, D. P., Daiello, L. A., Mor, V., & Berry, S. D.
- Affiliations
- Brown University (US)
- Beth Israel Deaconess Medical Center (US)
- Corresponding author
- Zullo, Andrew R.
- ORCID
- Venue
- Journal of the American Medical Directors Association
- Publisher
- Elsevier BV
- Published
- 2018-02
- Volume
- 19
- Issue
- 2
- Pages
- 174-176
- ISSN
- 1525-8610 (ISSN-L)
- PMC
- PMC5803325
- OpenAlex
- W2777786745
- Semantic Scholar
- 620616fc49da9f92c6e0df0ae1b12ce874fdb186
- Cited by
- 12
- References
- 17
- Citations by year
- 2025: 2 · 2024: 4 · 2023: 1 · 2021: 1 · 2020: 2 · 2019: 2
- FWCI
- 1.63
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American Medical Directors Association (acceptedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Office of Academic Affiliations, Department of Veterans Affairs
- National Institute on Aging (5R01AG045441)
- Agency for Healthcare Research and Quality (5K12HS022998)
- Health Services Research and Development
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Medicine › Surgery › Hip and Femur Fractures
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Keywords
- hip fracture, opioid analgesics, non-opioid analgesics, nursing home residents, older adults, postoperative pain management, mortality, functional decline, activities of daily living, paracetamol, nonsteroidal anti-inflammatory drugs
- MeSH terms
- Aged, Aged, 80 and over, Analgesics, Analgesics, Opioid, Female, Follow-Up Studies, Medicare, Hip Fractures, Humans, Male, Nursing Homes, Postoperative Pain, Retrospective Studies, United States, Drug Utilization Review
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
