A systematic review of opioid prevalence in Australian residential aged care facilities

Dowd, Laura A; Reynolds, Lorenna; Cross, Amanda J.; Veal, Felicity; Steeper, Michelle; Wanas, Zainab; Wu, Nancy; Bell, Jane

doi:10.1111/ajag.13071

Cited by 5 publications

(2 citation statements)

References 71 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our analgesic comparison identified a 30-fold difference in regular opioid prevalence (30% vs 1%) between samples of Australian and Japanese residents. Opioid prevalence in the Australian sample was consistent with 2022 a systematic review which reported 28–34% of Australian residents used opioids on a regular basis over 1-week to 1-month [ 34 ]. Japan’s low opioid prevalence in the general population (<0.1% in 2017) has been previously attributed to cultural contexts, strict regulations, variable understanding of pain and fear of ADEs [ 11 , 12 , 35 , 36 ].…”

Section: Discussionsupporting

confidence: 83%

A mixed-methods study on the pharmacological management of pain in Australian and Japanese nursing homes

Dowd,

Hamada,

Hattori

et al. 2024

Age and Ageing

Self Cite

View full text Add to dashboard Cite

Background Understanding how analgesics are used in different countries can inform initiatives to improve the pharmacological management of pain in nursing homes. Aims To compare patterns of analgesic use among Australian and Japanese nursing home residents; and explore Australian and Japanese healthcare professionals’ perspectives on analgesic use. Methods Part one involved a cross-sectional comparison among residents from 12 nursing homes in South Australia (N = 550) in 2019 and four nursing homes in Tokyo (N = 333) in 2020. Part two involved three focus groups with Australian and Japanese healthcare professionals (N = 16) in 2023. Qualitative data were deductively content analysed using the World Health Organization six-step Guide to Good Prescribing. Results Australian and Japanese residents were similar in age (median: 89 vs 87) and sex (female: 73% vs 73%). Overall, 74% of Australian and 11% of Japanese residents used regular oral acetaminophen, non-steroidal anti-inflammatory drugs or opioids. Australian and Japanese healthcare professionals described individualising pain management and the first-line use of acetaminophen. Australian participants described their therapeutic goal was to alleviate pain and reported analgesics were often prescribed on a regular basis. Japanese participants described their therapeutic goal was to minimise impacts of pain on daily activities and reported analgesics were often prescribed for short-term durations, corresponding to episodes of pain. Japanese participants described regulations that limit opioid use for non-cancer pain in nursing homes. Conclusion Analgesic use is more prevalent in Australian than Japanese nursing homes. Differences in therapeutic goals, culture, analgesic regulations and treatment durations may contribute to this apparent difference.

show abstract

Section: Discussionsupporting

confidence: 83%

A mixed-methods study on the pharmacological management of pain in Australian and Japanese nursing homes

Dowd,

Hamada,

Hattori

et al. 2024

Age and Ageing

Self Cite

View full text Add to dashboard Cite

show abstract

“…Recent guidelines recommend a maximum dose of 3000 mg/day for frail older adults or those with low body weight (< 50 kg) [ 8 – 10 ]. Opioids are highly prevalent, with five Australian studies reporting that 28–34% of residents are prescribed regular opioids over periods from 1 week to 1 month [ 11 ]. A meta-analysis of previous research reported an association between opioids and falls (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.4–1.9) [ 12 ], with opioids being one of three medication classes implicated in 60% of ADE-related emergency department presentations among older adults in the United States (US) [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Identifying Residents Who May Benefit from an Analgesic Review: Applying Analgesic Indicators in Residential Aged Care Services

et al. 2023

Self Cite

View full text Add to dashboard Cite

Background Ensuring safe and effective analgesic use in residential aged care services is important because older adults are susceptible to analgesic-related adverse drug events (ADEs). Objective The aim of this study was to identify the proportion and characteristics of residents of aged care services who may benefit from analgesic review based on indicators in the 2021 Society for Post-Acute and Long-Term Care Medicine (AMDA) Pain Management Guideline. Methods Cross-sectional analyses of baseline data from the Frailty in Residential Sector over Time (FIRST) study ( N = 550 residents) across 12 South Australian residential aged care services in 2019 were conducted. Indicators included the proportion of residents who received > 3000 mg/day of acetaminophen (paracetamol), regular opioids without a documented clinical rationale, opioid doses > 60 mg morphine equivalents (MME)/day, more than one long-acting opioid concurrently, and a pro re nata (PRN) opioid on more than two occasions in the previous 7 days. Logistic regression was performed to investigate factors associated with residents who may benefit from analgesic review. Results Of 381 (69.3%) residents charted regular acetaminophen, 176 (46.2%) were charted > 3000 mg/day. Of 165 (30%) residents charted regular opioids, only 2 (1.2%) had no prespecified potentially painful conditions in their medical record and 31 (18.8%) received > 60 MME/day. Of 153 (27.8%) residents charted long-acting opioids, 8 (5.2%) received more than one long-acting opioid concurrently. Of 212 (38.5%) residents charted PRN opioids, 10 (4.7%) received more than two administrations in the previous 7 days. Overall, 196 (35.6%) of 550 residents were identified as potentially benefiting from analgesic review. Females (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.20–2.91) and residents with prior fracture (OR 1.62, 95% CI 1.12–2.33) were more likely to be identified. Observed pain (OR 0.50, 95% CI 0.29–0.88) was associated with a lower likelihood of being identified compared with residents with no observed pain. Overall, 43 (7.8%) residents were identified based on opioid-related indicators. Conclusions Up to one in three residents may benefit from a review of their analgesic regimen, including 1 in 13 who may benefit from a specific review of their opioid regimen. Analgesic indicators represent a new approach to target analgesic stewardship interventions. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-023-01025-5.

show abstract

Minimising Harm and Managing Pain: Deprescribing Opioids in Older Adults

Langford,

Schneider,

Reeve

et al. 2024

Drugs Aging

View full text Add to dashboard Cite

Approximately one in three older adults (aged 65 years and over) experience pain, negatively impacting their quality of life. Opioid analgesics are commonly prescribed to manage pain; however, balancing the benefits and harms of these high-risk analgesics can be challenging for both healthcare professionals and patients. This is particularly true for older adults, as factors such as polypharmacy, age-related physiological changes and cognitive decline may impact upon opioid safety and efficacy. Deprescribing is the patient-centred process of reducing or discontinuing a medication that is no longer appropriate, or where the risks of continuation are deemed to outweigh the anticipated benefits. Opioid deprescribing has been proposed as a mechanism to reduce individual and societal opioid-related harm; however, to date, research has predominantly focused on the general adult population, rather than older adults. This current opinion aims to summarise the existing opioid deprescribing literature, discussing its applicability for older adults. Drawing on a non-systematic review of the literature, it identifies unique challenges and considerations for this population, highlights international initiatives to enhance opioid deprescribing in clinical practice and proposes future directions to advance the field.

show abstract

A systematic review of opioid prevalence in Australian residential aged care facilities

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 5 publications

References 71 publications

A mixed-methods study on the pharmacological management of pain in Australian and Japanese nursing homes

A mixed-methods study on the pharmacological management of pain in Australian and Japanese nursing homes

Identifying Residents Who May Benefit from an Analgesic Review: Applying Analgesic Indicators in Residential Aged Care Services

Minimising Harm and Managing Pain: Deprescribing Opioids in Older Adults

Contact Info

Product

Resources

About