Use of Opioids Increases With Age in Older Adults: An Observational Study (2005–2017)

Weesie, Yvette M.; Hek, Karin; Schermer, Tjard; Schellevis, F.G.; Leufkens, H.G.M.; Rook, Elisabeth J.; Dijk, Liset van

doi:10.3389/fphar.2020.00648

Cited by 15 publications

(13 citation statements)

References 26 publications

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“…Clinical decision tools can support prescribers in rational (de-) prescribing decision making. from 1.3 to 7.0% [19]. The increase was highest among persons aged 85 years and over.…”

Section: Key Pointsmentioning

confidence: 86%

Opioids and Falls Risk in Older Adults: A Narrative Review

et al. 2022

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Pain treatment is important in older adults but may result in adverse events such as falls. Opioids are effective for nociceptive pain but the evidence for neuropathic pain is weak. Nevertheless, both pain and opioids may increase the risk of falls. This narrative literature review aims to summarize the existing knowledge on the opioid-related fall risk in older adults, including the pharmacokinetics and pharmacodynamics, and assist clinicians in prescribing and deprescribing opioids in older persons. We systematically searched relevant literature on opioid-related fall risk in older adults in PubMed and Scopus in December 2020. We reviewed the literature and evaluated fall-related adverse effects of opioids, explaining how to optimally approach deprescribing of opioids in older adults. Opioid use increases fall risk through drowsiness, (orthostatic) hypotension and also through hyponatremia caused by weak opioids. When prescribing, opioids should be started with low dosages if possible, keeping in mind their metabolic genetic variation. Falls are clinically significant adverse effects of all opioids, and the risk may be dose dependent and highest with strong opioids. The risk is most prominent in older adults prone to falls. To reduce the risk of falls, both pain and the need for opioids should be assessed on a regular basis, and deprescribing or changing to a lower dosage or safer alternative should be considered if the clinical condition allows. Deprescribing should be done by reducing the dosage gradually and by assessing and monitoring the pain and withdrawal symptoms at the same time. Weighing the risks and benefits is necessary before prescribing opioids, especially to older persons at high risk of falls. Clinical decision tools assist prescribers in clinical decisions regarding (de-) prescribing.

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“…Clinical decision tools can support prescribers in rational (de-) prescribing decision making. from 1.3 to 7.0% [19]. The increase was highest among persons aged 85 years and over.…”

Section: Key Pointsmentioning

confidence: 86%

Opioids and Falls Risk in Older Adults: A Narrative Review

et al. 2022

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“…First, the number of patients in the elderly population increased. Age is closely associated with increasing opioid consumption [24]. Studies from European countries between 2000 and 2010 reported that consumption of strong opioids was highest among patients aged 66-80 years [21,25].…”

Section: Discussionmentioning

confidence: 99%

Recent trends in opioid prescriptions in Korea from 2002 to 2015 based on the Korean NHIS-NSC cohort

et al. 2022

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Cohort between 2002 and 2015. Methods: Morphine milligram equivalent (MME) was calculated to standardize the relative potency of the opioids. The number (cases) or amount (MME) of annual opioid prescription per 10,000 registrants was computed to analyze trends of consumption of opioids after age standardization. Joinpoint regression analysis was conducted to calculate the annual percentage change and average annual percentage change (AAPC). Results: The number (cases) of prescriptions per 10,000 registrants increased from 0.07 in 2002 to 41.23 in 2015 (AAPC [95% CIs], 76.0% [61.6-91.7%]). The MME per 10,000 registrants increased from 15.06 in 2002 to 40,727.80 in 2015 (AAPC [95% CIs], 103.0% [78.2-131.3%]). The highest AAPC of prescriptions and MME per 10,000 registrants were observed in the elderly (60-69 years) and at general hospitals. Fentanyl prescription increased most rapidly among four opioids. Conclusions: Consumption of opioids greatly increased in South Korea over 14 years.

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“…Chemotherapy, androgen receptor-targeted drugs, and radionuclides were used to indicate CRPC because it was the only indication for these treatments during the study period. Initially, we included bone pain and opioid use in our assessment because bone pain is often present in men with metastatic PCa, but we subsequently excluded these factors as they are not specific for PCa progression, especially in older men with multiple comorbidities [26,27].…”

Section: Discussionmentioning

confidence: 99%

Evidence of cancer progression as the cause of death in men with prostate cancer in Sweden

et al. 2022

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To assess the strength of the evidence indicative of prostate cancer (PCa) progression as the adjudicated cause of death, according to age at death and PCa risk category. Patients and MethodsUsing data from the Prostate Cancer data Base Sweden, we identified a study frame of 5543 men with PCa registered as the cause of death according to the Cause of Death Register. We assessed the evidence of PCa progression through a review of healthcare records for a stratified sample of 495/5543. We extracted data on prostate-specific antigen levels, presence of metastases on imaging, and PCa treatments, and quantified the evidence of disease progression using a points system. ResultsBoth no evidence and moderate evidence for PCa progression was more common in men aged >85 years at death than those aged <85 years (29% vs 14%). Among the latter, the proportion with no evidence or moderate evidence for PCa progression was 21% for low-risk, 14% for intermediate-risk, 8% for high-risk, and 0% for metastatic PCa. In contrast, in men aged >85 years, there was little difference in the proportion with no evidence or moderate evidence of PCa progression between PCa risk categories; 31% for low-risk, 29% for intermediate-risk, 29% for high-risk, and 21% for metastatic PCa. Of the 5543 men who died from PCa, 13% (95% confidence interval 5-19%) were estimated to have either no evidence or moderate evidence of PCa progression. ConclusionsWeak evidence for PCa progression as cause of death was more common in older men with PCa and in those with low-risk PCa. This has implications for interpretation of mortality statistics especially when assessing screening and early treatment of PCa because the beneficial effect of earlier diagnosis could be masked by erroneous adjudication of PCa as cause of death in older men, particular those with localised disease at diagnosis.

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Use of Opioids Increases With Age in Older Adults: An Observational Study (2005–2017)

Cited by 15 publications

References 26 publications

Opioids and Falls Risk in Older Adults: A Narrative Review

Opioids and Falls Risk in Older Adults: A Narrative Review

Recent trends in opioid prescriptions in Korea from 2002 to 2015 based on the Korean NHIS-NSC cohort

Evidence of cancer progression as the cause of death in men with prostate cancer in Sweden

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