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Researchers from Rigshospitalet-University of Copenhagen, Aarhus University, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, all in Denmark, have knocked over some assumptions about how pain is treated in the elderly in Denmark, especially nursing home residents with dementia.
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The study of 870,645 adults without dementia and 35,455 with dementia is the first to examine opioid use in an entirely elderly population, the researchers say. Contrary to their hypothesis going in, they discovered pain was not undertreated in elderly patients—but rather might be overtreated in some. In fact, opioid treatment was “particularly pronounced among the most vulnerable”; that is, patients with dementia (32%) and nursing home residents (41%). Nursing home residents with dementia received opioids less frequently than did those without dementia, but this was due to fewer receiving weak opioids, the researchers say.
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Another hypothesis was also dashed, because the use of opioids rose steadily with age. Moreover, nearly 80% of nursing home residents with dementia received > 1 opioid prescription. They were also treated for longer periods than were home-living patients: Half of nursing home patients with dementia were on opioids for > 112 days, compared with > 93 days for home-living patients with dementia.
The findings raise concerns, the researchers say. Clinical trials of analgesics have not included patients with dementia and nursing home residents, who represent the frailest patient groups. Few data, the researchers note, support evidence-based prescribing of opioids in these patients; evidence for long-term use is also limited.
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Their results also contrast with most studies on home-living patients with dementia, they say, which have found that patients with dementia receive fewer analgesics. However, they add, use of opioids is on the rise in general: In Denmark alone, use increased by 34% between 1999 and 2010. Their findings thus may also have clinical benefit elsewhere.
Source
Jensen-Dahm C, Gasse C, Astrup A, Mortensen PB, Waldemar G. Alzheimers Dement. 2015;11(6):691-699.
doi: 10.1016/j.jalz.2014.06.013.