Tolerability of buprenorphine transdermal system in nursing home patients with advanced dementia: a randomized, placebo-controlled trial (DEP.PAIN.DEM)

Erdal, Ane; Flo, Elisabeth; Aarsland, Dag; Selbæk, Geir; Ballard, Clive; Slettebø, Dagrun D.; Husebø, Bettina S.

doi:10.2147/cia.s161052

Cited by 40 publications

(31 citation statements)

References 43 publications

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“…Several warnings have been issued against using fentanyl patches in non-opioid-tolerant patients because of serious adverse events and deaths [38]. In a recent study of tolerability of buprenorphine in nursing home residents with advanced dementia, 52.3% discontinued treatment due to adverse events, with sedation/somnolence being the most frequent, compared with 13.3% in the placebo group [39]. Thus, the greater increase in opioid use among elderly with dementia, is a cause for concern.…”

Section: Discussionmentioning

confidence: 99%

The Use of Opioids and Antipsychotics in Elderly with Dementia – Have Opioids Replaced Antipsychotics in Treating Behavioral Symptoms in Dementia?

Jensen‐Dahm

Christensen

Gasse

et al. 2020

JAD

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Background: Opioids are used with increasing frequency. Elderly with dementia are prescribed opioids more frequent than elderly without. One possible explanation is that opioids may be used not only to treat pain but also behavioral symptoms. Objective: To test the hypothesis that strong opioid use, especially transdermal formulations, had increased, especially in elderly with dementia, in parallel with a decrease in antipsychotic use. Methods: Population-based cross-sectional study conducted using nationwide Danish registers with data on Denmark's entire elderly population age ≥65 (2000: n = 802,106; 2015: n = 1,056,476). The registers were used to identify elderly with and without dementia and filled prescriptions for opioids and antipsychotics. Annual prevalence of opioid and antipsychotic use from 2000-2015 was calculated. Results: Prevalence of opioid use increased by 35% (24.2 to 32.5%) among elderly with dementia and by 13% among elderly without (14.9 to 16.8%) from 2000-2015. The disproportionate increase in opioid use among elderly with dementia was mainly driven by an increase in strong opioids (dementia: 11.7 to 23.1%; without dementia: 5.9 to 7.4%). Use of antipsychotics decreased during the same period (dementia: 31.3 to 19.3%; no dementia: 4.5 to 2.7%). Conclusion: From 2000-2015, use of opioids among the elderly increased with a disproportionately higher increase among elderly with dementia. The parallel decrease in the use of antipsychotics may suggest that opioids to some extent have replaced antipsychotics in managing behavioral symptoms, despite safety concerns and lack of evidence for effect of opioids. Future research should focus on potential risks associated with increased opioid use.

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Section: Discussionmentioning

confidence: 99%

The Use of Opioids and Antipsychotics in Elderly with Dementia – Have Opioids Replaced Antipsychotics in Treating Behavioral Symptoms in Dementia?

Jensen‐Dahm

Christensen

Gasse

et al. 2020

JAD

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“…Further, antidepressant use, which may increase the serotonergic adverse effects of tramadol, is common among persons with AD [53]. However, clinicians should be aware that buprenorphine adverse effects, such as somnolence, may be more pronounced among concomitant antidepressant users with dementia [54,55]. Regular assessment of pain and the need for opioids, as well as the benefits and harms of opioid therapy, should be conducted, regardless of the route of administration.…”

Section: Discussionmentioning

confidence: 99%

Opioid Use After Hospital Care due to Hip Fracture Among Community-Dwelling Persons With and Without Alzheimer’s Disease

et al. 2019

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Background Hip fractures are common among persons with Alzheimer's disease (AD), but problems in pain assessment may lead to insufficient analgesia after hospitalization. Objective We investigated the prevalence of opioid use in the 6 months after discharge from hospital care due to hip fracture among community-dwellers with and without AD. Setting and method The Medication use and Alzheimer's disease (MEDALZ) cohort was used for this study, consisting of all community-dwelling persons newly diagnosed with AD during 2005-2011 in Finland and their comparison persons without AD matched on age, sex, and region of residence at the time of AD diagnosis. Data were collected from nationwide healthcare registers. Main outcome measures We investigated opioid use versus non-use in persons with and without AD in the 6 months after discharge from hospital care due to hip fracture. Results Altogether 2342 persons with AD and 1615 persons without AD, discharged to community settings within ≤ 120 days after a hip fracture, were included. A higher percentage of persons with AD used opioids compared to those without AD, 39.5% [95% confidence interval (CI) 37.5-41.5] versus 31.2% (95% CI 28.9-33.5). Persons with AD used more frequently strong opioids during the first 3 months and buprenorphine during the 6-month period, and used weak opioids less frequently after the first month after discharge compared to those without AD. Conclusions Frequent opioid use after hospital care due to hip fracture may indicate increased attention to pain among persons with AD. Nevertheless, the benefits and harms of opioid use should be evaluated regularly in community-dwelling older persons.

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“…Nurses can assess pain through a variety of pain assessment tools [18], but the quality and utility of these tools have been questioned [19][20][21]. Further, opioids are usually the first choice for analgesia at the end of life [22], but there is evidence that those with advanced dementia respond poorly to opioid treatment and experience more harmful side effects than people without dementia [22,23]. Since persons with dementia at the end of life find it difficult, or are unable, to self-report pain, many of the available pain assessment tools cannot be used [24].…”

Section: Introductionmentioning

confidence: 99%

End-of-life care for people with advanced dementia and pain: A qualitative study in Swedish nursing homes

Lundin¹,

Godskesen

2020

Preprint

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Background: Of the Swedish people with advanced dementia, the majority die in nursing homes. Unresolved pain can occur in people with a terminal illness such as dementia. However, pain management in people with advanced dementia is often suboptimal and inadequate, with fewer palliative care interventions than offered to cancer patients. Although they are largely responsible for the care of these people, few studies have addressed the experiences of registered nurses in this respect. Therefore, the aim of this study was to describe the experiences of nurses in caring for people with advanced dementia and pain at the end of life.Methods: The study had a descriptive explorative design. Individual qualitative, semi-structured interviews were carried out with thirteen nurses from twelve nursing homes in Sweden. The results were analysed using thematic content analysis.Results: The nurses described communicative, relational and organisational challenges. One major issue involved difficulties in communicating with the person with advanced dementia, resulting in uncertain pain assessment. Other difficulties involved the differentiation of pain from anxiety, the balance of benefits and risks with morphine administration, and the creation of good relationships with healthcare personnel and the persons’ relatives. Relatives can greatly affect the assessment and management of pain, both because of their ability to interpret pain behaviour and by questioning the care given. Good pain management was facilitated by good communication and relationships with healthcare staff and relatives, extensive professional nursing experience, and already knowing the person with advanced dementia. Conclusions: This study highlights the need for nursing homes to employ specialist nurses who have been trained in the appropriate knowledge and skills to deal with the challenges of end-of-life care for people with advanced dementia and pain. Additionally, there should be resources and strategies available for providing information to family members and for involving them in the decision-making process, as they are often unfamiliar with the multitude of considerations involved in decisions such as whether to administer morphine or not.

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Tolerability of buprenorphine transdermal system in nursing home patients with advanced dementia: a randomized, placebo-controlled trial (DEP.PAIN.DEM)

Cited by 40 publications

References 43 publications

The Use of Opioids and Antipsychotics in Elderly with Dementia – Have Opioids Replaced Antipsychotics in Treating Behavioral Symptoms in Dementia?

The Use of Opioids and Antipsychotics in Elderly with Dementia – Have Opioids Replaced Antipsychotics in Treating Behavioral Symptoms in Dementia?

Opioid Use After Hospital Care due to Hip Fracture Among Community-Dwelling Persons With and Without Alzheimer’s Disease

End-of-life care for people with advanced dementia and pain: A qualitative study in Swedish nursing homes

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