Incident Functional Limitations Among Community-Dwelling Adults Using Opioids: A Retrospective Cohort Study Using a Propensity Analysis with the Health and Retirement Study

Background: Opioid analgesics are commonly used to manage pain; however, it is unclear how they affect patient function. This study examines the association between opioid analgesics and incident limitations in activities of daily living (ADL), instrumental activities of daily living (IADL), and cognitive functioning among community-dwelling older adults. Methods: Data included 10,003 participants of the 2016 and 2018 waves of the Health and Retirement Study, which sampled US adults aged 51–98 years. The primary exposure was self-reported opioid pain medication use in 2016. Outcomes included incident limitations in ADL, IADL, and cognitive functioning in 2018. Statistical methods adjusted for confounding using multivariable logistic regressions, inverse probability of treatment weighting, and propensity scores. Results: Opioid use (adjusted odds ratio [aOR]: 1.34, 95% confidence interval [CI] 1.07–1.68) was associated with a statistically significant higher odds of incident ADL limitation in multivariable regression and in propensity score adjustment (aOR: 1.41, 95% CI 1.13–1.76). The association between opioid use and ADL and IADL limitations was modified by age. Adults aged < 65 years had a higher odds of incident ADL (aOR: 1.83, 95% CI 1.38–2.42) and IADL (aOR: 1.42, 95% CI 1.06–1.90) limitations compared with those aged ≥ 65 years. Conclusions: Community-dwelling adults using opioid analgesics to manage pain may be at risk for incident ADL limitations. Middle-aged adults, compared with those older than 65 years of age, experienced the greatest odds for incident ADL and IADL limitations following opioid use. According to sensitivity analyses, our findings were robust to unmeasured confounding.