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New Opioid Use Puts Older Adults With Dementia at Higher Risk of Death
New opioid use by older adults with dementia has been associated with a significantly increased risk of death, including an 11-times higher risk within the first 2 weeks of initiating opioid use, according to a study released on Tuesday at the Alzheimer’s Association International Conference in Amsterdam, Netherlands.
The study included 75,471 adults at least 65 years of age who were diagnosed with dementia between January 1, 2008, and December 31, 2018. Among the study population, 42% redeemed a prescription for an opioid at a pharmacy.
Study participants were tracked for 180 days after their first opioid prescription. Researchers also tracked a group of older adults with dementia who did not receive an opioid prescription during the same period. The study produced the following findings:
Among dementia patients who initiated their first opioid prescription, 33.1% died within 180 days compared to 6.4% of those without an opioid prescription.
The greatest discrepancy between patient groups studied came in the first 14 days after opioid initiation, where those who began taking an opioid faced an elevenfold risk of death over those who did not.
Morphine, oxycodone, ketobemidone, hydromorphone, pethidine, buprenorphine, and fentanyl—used to relieve pain when non-opioid and mild opioid medicines were deemed ineffective—were classified by researchers as “strong opioids.” This class of opioids was associated with a sixfold increase in mortality risk.
Among patients who used fentanyl patches as their first prescription, 64.4% died within 180 days.
In a news release announcing the findings, Christina Jensen-Dahm, MD, PhD, of the Neurology Department, Danish Dementia Research Centre, Copenhagen University Hospital — Rigshospitalet, Denmark, called the study’s findings “worrisome.”
“The use of strong opioids has increased considerably over the past decade among older people with dementia,” Dr Jensen-Dahm said. “Our study shows the importance of careful evaluation of risk and benefits to the patient when considering initiating opioid therapy among elderly individuals with dementia.”
Given the known side effects of opioids, such as sedation, confusion, respiratory depression, and falls, discretion when prescribing opioids to older adults with dementia should be exercised, Dr Jensen-Dahm added.
We suspect this is why they cannot tolerate opioids, but we do not know for certain and need to do more research to answer these questions,” she said.
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