Acetaminophen Safety: Risk of Mortality and Cardiovascular Events in Nursing Home Residents, a Prospective Study

J Am Geriatr Soc. 2019 Jun;67(6):1240-1247. doi: 10.1111/jgs.15861. Epub 2019 Mar 26.

Abstract

Background: Acetaminophen is the most widely used analgesic today. A recent systematic review found increased adverse events and mortality at therapeutic dosage. Our aim was to challenge these results in a large sample of older adults living in nursing homes (NHs).

Design: Prospective study using data from the Impact of Educational and Professional Supportive Interventions on Nursing Home Quality Indicators project (IQUARE), a multicenter, individually tailored, nonrandomized controlled trial in NHs across southwestern France.

Setting/participants: We studied data from 5429 participants living in 175 NHs (average age, 86.1 ± 8.1 years; 73.9% women).

Measurements: All prescriptions obtained at baseline were analyzed by a pharmacist for acetaminophen use as stand-alone or associated. Myocardial infarction (MI) and strokes were reported from participants' medical records at 18-month follow-up. Dates of death were obtained. Data collection was done through an online questionnaire at baseline and at 18 months by NH staff. Analyses were realized in our total population and a population matched on propensity score of acetaminophen intake. Six models were run for each outcome.

Results: A total of 2239 participants were taking, on average, 2352 ± 993 mg of acetaminophen daily. Results for mortality were: hazard ratio (HR) = 0.97 (95% confidence interval [CI] = 0.86-1.10). No associations between acetaminophen intake and the risk of mortality or MI were found. In one of our models, acetaminophen intake was associated with a significant increased risk of stroke in diabetic subjects (OR = 3.19; 95% CI = 1.25-8.18; P = .0157). [Correction added March 16, 2019, after first publication online. In the previous sentence, "HR" was mistakenly used instead of "OR".] CONCLUSION: Despite old age, polypharmacy, and polymorbidity, acetaminophen was found safe for most, but not all, of our NH study population. Pain management in NHs is a health priority, and acetaminophen remains a good therapeutic choice as a first-line analgesic. More studies are needed on older diabetic patients.

Keywords: acetaminophen safety; geriatric; nursing home; pain management; propensity score.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetaminophen / therapeutic use*
  • Aged, 80 and over
  • Analgesics, Non-Narcotic / therapeutic use*
  • Female
  • France
  • Humans
  • Male
  • Mortality*
  • Myocardial Infarction* / mortality
  • Nursing Homes / statistics & numerical data
  • Pain Management*
  • Polypharmacy
  • Prospective Studies
  • Stroke* / mortality
  • Surveys and Questionnaires

Substances

  • Analgesics, Non-Narcotic
  • Acetaminophen