Abstract
BackgroundThe increasing trend of opioid use for non-malignant pain among older people has raised concerns about whether opioids are used for appropriate indications. On the other hand, pain in patients with dementia may be undertreated.AimsTo examine the prevalence of and indications for daily opioid use among home care clients, and to determine opioid use differs between those with and without dementia.MethodsAll home care clients aged ≥ 65 years using opioids daily (n = 282) were identified based on their first Resident Assessment Instrument–Home Care assessment in 2014. Exact indications for opioid use, the opioid substance used, the median duration of use, and changes in opioid medication within 12 months from study entry were obtained from the electronic medical records.ResultsThe prevalence of daily opioid use was 9.3%, and the median duration of use before the study entry was 357 days (interquartile range 126–719 days). The majority of clients continued to use opioids daily during the follow-up year. Vertebral osteoporotic fractures (21.6%), degenerative spinal disorders (20.9%), and osteoarthritis (20.6%) were the most common indications for opioid use. Buprenorphine was used more frequently in persons with dementia, but otherwise there were no differences between those with and without dementia.Discussion and conclusionsHome care clients use opioids for long periods of time for pain related mostly to musculoskeletal disorders, although the effectiveness of long-term opioid use is not clear. The lack of effective or suitable options for management of pain might explain the situation.
Highlights
The overall trend of opioid use for non-malignant pain has been increasing among older people regardless of the living setting [1,2,3]
This study was based on data from the Resident Assessment Instrument–Home Care (RAI–HC) that was supplemented by a retrospective review of local medical records
A total of 282 persons—9.3% of the home care clients assessed with the RAI-HC—were using opioids daily at the time of their first RAI-HC in 2014
Summary
The overall trend of opioid use for non-malignant pain has been increasing among older people regardless of the living setting [1,2,3]. The reported prevalence of daily pain has been reported to be up to 60% of the study population among older home care clients in previous studies [7, 9]. The increasing trend of opioid use for non-malignant pain among older people has raised concerns about whether opioids are used for appropriate indications. Aims To examine the prevalence of and indications for daily opioid use among home care clients, and to determine opioid use differs between those with and without dementia. Results The prevalence of daily opioid use was 9.3%, and the median duration of use before the study entry was 357 days (interquartile range 126–719 days). Discussion and conclusions Home care clients use opioids for long periods of time for pain related mostly to musculoskeletal disorders, the effectiveness of long-term opioid use is not clear. The lack of effective or suitable options for management of pain might explain the situation
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