Jenny Wei sheds light on mindful medication practices for older adults
Whether sitting in a hospital waiting room, physical exam office or community pharmacy, you can count on meeting the uncanny, uncomfortable gaze of six perfectly circular faces. They sit under a film of laminate, expressing a pain response from zero to 10.
These familiar strangers are the Wong-Baker Faces, a numerical descriptor scale (NDS) developed in 1983 that attempts to quantify pain and bridge the gap between care teams and patient needs. And while this scale has been incredibly useful for communicating pain, the measure of pain is not often in observational research on pain management.
As much as we might hope that a course of pain management can be selected by identifying the face of a patient’s discomfort, personalized treatment must take a patient’s background and potential treatment effects into consideration.
For decades, data on pain management in older adults has been severely lacking, hindering the ability of prescribers to find the strongest methods to treat this diverse group.
Enter Jenny Wei; associate professor in the Division of Outcomes and Translational Sciences at The Ohio State University College of Pharmacy.
The numbers of aging
Dr. Wei has dedicated her career to researching the health of older adults. She first applied her data analysis expertise to the demographic as a member of the University of Maryland’s Pharmaceutical Health Services PhD program, where she became the first graduate student to analyze prescription claims data from Medicare Part D.
“Gerontological Pharmacoepidemiology was a new field for me to break into,” Dr. Wei noted, recalling her hesitancy to take on this new focus. “But leading that new wave of analysis on older populations sparked the passion that I have today.”
Her research has evolved to investigate older adults with neurodegenerative disorders. Most recently, she’s shown how opioid prescribing practices in this population affect the group’s overall wellness.
The aging population is increasing. Not only in the United States but all over the world. Researching these conditions that mostly affect geriatric populations is a way we can get ahead of the demographic shift and health care challenges of a rising number of older adults.
Creating a stronger plan for pain management
Dr. Wei’s research has been heavily supported by the results of the Medicare claims data linked to Minimum Data Set (MDS). MDS is a federally mandated clinical assessment that routinely reports individuals’ functional (including pain assessment), medical, psychosocial and mental status in Medicare- or Medicaid-certified nursing homes.
“I proposed to my mentors at the University of Florida to use both Medicare and MDS data to investigate pain treatment practices, taking the data of pain into consideration.” Dr. Wei said. “It’s proven to be very valuable. I’m still investigating it and making new discoveries today.”
Though pain management research and treatment has received an influx of attention since the unfolding of the opioid epidemic beginning in the 1990s, much of the existing attention is directed toward young and middle-aged adults. “It’s not often assumed that older adults are using opioids in a problematic way because we see that it’s usually prescribed for pain,” Dr. Wei said. “But there’s no clinical pain guideline for this demographic with the highest opioid consumption. That leaves many questions about how to appropriately prescribe opioids to achieve treatment goals for this older population.”
Greater portions of those 65 and older experience chronic pain compared to their younger peers. Among older adults with Alzheimer’s disease and related dementias, three in four report regular pain. Yet pain treatment for these groups remains troublingly one-dimensional.
“Current CDC guidelines recommend tapering and discontinuing long-term opioid therapy (LTOT) for patients without cancer or not receiving palliative care when associated risks outweigh the benefits of treatment,” Dr. Wei explained. “That includes those with Alzheimer’s disease. However, data about what those associated 'risks’ and ‘benefits’ look like for patients with Alzheimer’s and related dementias is not currently available.”
In October 2023, Dr. Wei was published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association. The paper, “Pain intensity, physical function, and depressive symptoms associated with discontinuing long-term opioid therapy in older adults with Alzheimer’s disease and related dementias,” explores the clinical benefits of older adults using opioids for extended periods of time. In January 2024, another paper accepted by Age and Aging, “Short- and Long-Term Safety of Discontinuing Chronic Opioid Therapy Among Older Adults with Alzheimer’s Disease and Related Dementia,” illustrates the adverse effects of such opioid prescribing practices.
By taking the time to develop the data surrounding an often-neglected demographic, Dr. Wei has shed light on why personalization of care is so key. Her research does not qualify opioid treatment of pain as completely wrong or right, but instead allows prescribers to understand the implications of their prescribing practices for older adults experiencing neurodegenerative conditions.