The prevalence of and exact indications for daily opioid use among aged home care clients with and without dementia

Mörttinen-Vallius, Heidi; Hartikainen, Sirpa; Seinelä, Lauri; Jämsen, Esa

doi:10.1007/s40520-020-01627-8

Cited by 9 publications

(12 citation statements)

References 40 publications

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“…Strong opioids comprised the majority of opioids used in our study, with the most prevalent being oxycodone both years. Buprenorphine, a partial agonist/antagonist, has become increasingly prescribed to people with major NCD [30], and in our study, 28% of those taking opioids were using this drug in 2017. Buprenorphine that is administered as a transdermal patch formulation might be an alternative in, for example, people with non-adherence or swallowing difficulties.…”

Section: Discussionmentioning

confidence: 57%

Pharmacological Pain Treatment in 2012 and 2017 Among Older People with Major Neurocognitive Disorder

2021

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Background and Objective Pain is highly prevalent among older people, and treatment is complicated because of comorbidities and polypharmacy. Among people with major neurocognitive disorder additional difficulties might arise. The aim of this study was to describe analgesic drug use in 2012 and 2017 and associated factors among older people with major neurocognitive disorder. Methods In this register-based study, the Swedish Dementia Registry and the Swedish Prescribed Drug Register were combined in order to obtain data regarding analgesic drug use among older people with major neurocognitive disorder. One or more filled prescriptions during the timeframe of 6 months (1 July-31 December 2012 and 1 July-31 December 2017) defined drug use during the respective period. A comparison between 2012 and 2017 was made, including a total of 56,101 people (20,889 and 35,212 respectively) with a mean age of 81.9 and 82.7 years, respectively. Results The overall use of analgesic drugs increased significantly from 41.6% of individuals to 46.0% between the years 2012 and 2017. Users of opioid analgesics (15.2% vs 17.3%) and paracetamol (37.0% vs 42.3%) increased, while the users of non-steroidal anti-inflammatory drugs (4.9% vs 2.7%) declined between the two data collections. Multiple logistic regression analyses were performed for different drugs and drug classes, and it was found that the use of opioids and paracetamol was associated with older age and a longer time since diagnosis. In contrast, non-steroidal anti-inflammatory drugs were associated with younger age and a shorter time since diagnosis. ConclusionsThe results indicate that on a population level, pharmacological drug treatment has changed in line with guidelines between 2012 and 2017, with an increase in paracetamol and strong opioids and a decrease in non-steroidal antiinflammatory drugs and tramadol. The relatively high prevalence of opioids warrants concern given the significant risk of adverse effects among older people with major neurocognitive disorder.

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Section: Discussionmentioning

confidence: 57%

Pharmacological Pain Treatment in 2012 and 2017 Among Older People with Major Neurocognitive Disorder

2021

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“…Despite this evidence, statements such as “pain is a normal part of the aging process,” “the older person who has dementia cannot feel pain,” or “if an older person does not verbalize pain, it does not exist” are often displayed amongst health care professionals and result in poor pain management for these elderly groups ( 33 , 34 ). Also, the belief that older adults should not be prescribed strong opioids results in avoidance of their use ( 35 , 36 ).…”

Section: Discussion/conclusionmentioning

confidence: 99%

Pain in Older Adults With Dementia: A Survey in Spain

et al. 2020

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The risk of suffering pain increases significantly throughout life, reaching the highest levels in its latest years. Prevalence of pain in nursing homes is estimated to range from 40 to 80% of residents, most of them old adults affected with dementia. It is already known that pain is under-diagnosed and under-treated in patients with severe cognitive impairment and poor/absent verbal communication, resulting in a serious impact on their quality of life, psychosocial, and physical functioning. Under-treated pain is commonly the cause of behavioral symptoms, which can lead to misuse of antipsychotic treatments. Here, we present two Regional and National Surveys in Spain (2015–2017) on the current practices, use of observational tools for pain assessment, guidelines, and policies. Results, discussed as compared to the survey across central/north Europe, confirm the professional concerns on pain in severe dementia, due to poor standardization and lack of guidelines/recommendations. In Spain, observational tools are scarcely used because of their difficulty and low reliability in severe dementia, since the poor/absent verbal communication and comprehension are considered limiting factors. Behavioral observation tools should be used while attending the patients, in a situation including rest and movement, should be short (3–5 min) and scored using a numeric scale. Among the pain items to score, “Facial expression” and “Verbalization” were considered essential and very useful, respectively. This was in contrast to “Body movements” and “Vocalizations,” respectively, according to the survey in central/north Europe. Scarce time availability for pain assessment and monitoring, together with low feasible and time-consuming tools, can make pain assessment a challenge. The presence of confounding factors, the low awareness and poor knowledge/education of specific tools for this population are worrisome. These complaints draw future directions to improve pain assessment. More time available, awareness, and involvement of the teams would also benefit pain assessment and management in cognitive impairment. The experiences and opinions recorded in these surveys in Spain and other E.U. countries were considered sources of knowledge for designing the “PAIC-15 scale,” a new internationally agreed-on meta-tool for Pain Assessment in Impaired Cognition and the “Observational pain assessment” in older persons with dementia.

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“…Comorbidities that could affect opioid use [ 3 , 23 ], could restrict the use of non-steroidal anti-inflammatory drugs [ 24 ], or are known indications for opioid use [ 1 ], included any documented cancer during the previous 5 years (except basalioma), any diagnosed cognitive or psychiatric disorder, a history of stroke, Parkinson’s disease, cardiac diseases (arrythmias, ischemic heart disease or congestive heart failure), chronic renal failure, peripheral arterial disease or venous insufficiency, diabetes, pressure ulcers, arthritis, osteoporosis or a history of any fracture affecting the present health status. Constipation, vomiting, dizziness, unsteady gait, urinary difficulties and hallucinations were regarded as symptoms that could represent the common adverse effects of opioids in the RAI-HC [ 12 , 14 , 25 , 26 ].…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Around one in ten home-dwelling older adults uses opioids, and the proportion is even greater when shorter periods of use are counted [ 1 – 4 ]. The most common indications for long-term opioid use among home care clients are musculoskeletal disorders, mainly vertebral osteoporotic fractures, degenerative spinal disorders and osteoarthritis [ 1 ]. Opioid use has been associated with the female gender, lower education and socioeconomic position, and polypharmacy among older community-dwelling adults [ 2 , 3 , 5 ], but associations with age, cardiovascular and pulmonary diseases, diabetes and impairment in activities of daily living have varied between studies [ 2 , 3 , 5 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Factors associated with daily opioid use among aged home care clients: a cross-sectional analysis of Resident Assessment Instrument data

et al. 2021

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Purpose To examine which client characteristics and other factors, including possible adverse effects, identified in the Resident Assessment Instrument—Home Care (RAI-HC) are associated with daily opioid use among aged home care clients. Methods The study sample comprised 2584 home care clients aged ≥ 65 years, of which 282 persons used opioids daily. Clients using opioids less than once daily were excluded. The cross-sectional data were gathered from each client’s first assessment with the RAI-HC during 2014. Multivariable logistic regression was used to study associations of daily opioid use with the clients’ characteristics and symptoms. Results Cognitive impairment was associated with less frequent opioid use after adjusting for pain-related diseases, disabilities and depressive symptoms (OR 0.43, 95% CI 0.32–0.58). The association was not explained by the estimated severity of pain. Osteoporosis, cancer within previous 5 years and greater disabilities in Instrumental Activities of Daily Living (IADL) were associated with daily opioid use regardless of the estimated severity of pain. Depressive symptoms and Parkinson’s disease were associated with daily opioid use only among clients with cognitive impairment, and disabilities in Activities of Daily Living, cancer, arthritis, fractures and pressure ulcers only among clients without cognitive impairment. Constipation was the only adverse effect associated with daily opioid use. Conclusion The pain of home care clients with cognitive impairment may not be treated optimally, whereas there might be prolonged opioid use without a sufficient evaluation of current pain among clients with osteoporosis, cancer within previous 5 years and disabilities in IADLs.

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The prevalence of and exact indications for daily opioid use among aged home care clients with and without dementia

Cited by 9 publications

References 40 publications

Pharmacological Pain Treatment in 2012 and 2017 Among Older People with Major Neurocognitive Disorder

Pharmacological Pain Treatment in 2012 and 2017 Among Older People with Major Neurocognitive Disorder

Pain in Older Adults With Dementia: A Survey in Spain

Factors associated with daily opioid use among aged home care clients: a cross-sectional analysis of Resident Assessment Instrument data

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