New opioid use increases death risk 11-fold in individuals with dementia.

New opioid use increases death risk 11-fold in individuals with dementia.

Opioid Use in Elderly Patients with Dementia: Balancing Risks and Benefits

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When it comes to managing pain in elderly patients with dementia, doctors face a tough challenge. A new study from researchers in Denmark has shed light on the risks of using opioid painkillers in this vulnerable population.

The Shocking Risk of Death

According to the research, starting opioid use after a dementia diagnosis significantly increases the risk of death. In fact, within the first two weeks of initiation, older adults with dementia who started using opioids faced an astonishing 11-fold increased risk of death. Although the risk decreased after two weeks, it remained elevated. The study concluded that doctors must carefully evaluate the risks versus benefits of opioid use in elderly patients with dementia.

Alarming Death Rates

The study examined the experiences of Danish patients diagnosed with Alzheimer’s disease over a 10-year period. Shockingly, the research found that one-third of patients who began taking opioids died within 180 days of their first dose. In contrast, only 6% of the non-opioid group died during the same time frame. These findings are concerning and warrant attention.

The Power of Fentanyl

The study also noted that when opioids were administered in the form of fentanyl patches, nearly two-thirds of patients died within the first 180 days. In contrast, only about 7% of those without opioid prescriptions experienced the same outcome. The high mortality rate associated with fentanyl patches raises concerns about the safety of this particular opioid in elderly patients with dementia.

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The Broader Picture

Overall, the study revealed a fourfold increased risk of excess death associated with opioids within the first six months. This risk persisted even after accounting for differences between groups. These findings have broader implications for the medical community, emphasizing the need for cautious opioid prescribing practices in older individuals, especially those with dementia.

The Importance of Risk-Benefit Evaluation

The U.S. Centers for Disease Control and Prevention (CDC) recommends that opioid therapy should only be considered for pain management if the benefits outweigh the risks. This guideline holds particular importance for older individuals with dementia, given the severe side effects opioids may cause. These side effects include sedation, confusion, respiratory depression, and increased risk of falls. Given that older adults with dementia are often frail, their ability to tolerate opioids is compromised. However, more research is needed to understand the underlying reasons for this intolerance.

A Call for Better Pain Management Strategies

The study included patients aged 65 and older who were diagnosed with dementia between 2008 and 2018. Approximately 42% of them filled a prescription for an opioid. Strong opioids such as morphine, oxycodone (OxyContin), and others were associated with a sixfold increased risk of death. This finding suggests that opioids, despite their pain-relieving properties, may put elderly patients with dementia at a significantly higher risk of dying.

Balancing Pain Relief and Patient Safety

Dr. Nicole Purcell, a neurologist and senior director of clinical practice at the Alzheimer’s Association, highlighted the significance of these findings. Dr. Purcell emphasized that pain should not be left untreated in individuals living with dementia, as they may have difficulty articulating the location and severity of their pain. However, she stressed the importance of thorough discussion between patients, their families, and physicians when considering opioid prescriptions. Any decision to use opioids should be made cautiously, with careful monitoring of the patient throughout the treatment process.

Revisiting Other Risky Drugs

It is important to note that opioids are not the only drugs associated with increased risks in older individuals with dementia. Previous research has shown that atypical antipsychotics nearly double the risk of death in this population. These findings serve as a reminder that multiple drugs commonly used in the elderly population can pose significant risks and must be carefully considered when prescribing.

Conclusion

The recent Danish study warns against the use of opioids in elderly patients with dementia. The increased risk of death, especially within the first two weeks, raises concerns about the safety of these drugs in this vulnerable population. Healthcare professionals need to balance the need for pain relief with the risks associated with opioid use, ensuring careful evaluation and patient monitoring. Future research is needed to further explore why older adults with dementia are more susceptible to opioid-related complications, allowing for the development of safer pain management strategies.

Sources – Alzheimer’s Association, news release, July 18, 2023 – U.S. National Institute on Aging – Alzheimer’s Disease Information