Raising Awareness of Opioid Use in Older Adults and the Elderly
SpineUniverse reported on a study that indicated a 10% increase in opioid addiction or dependency in patients prescribed such medications to treat postoperative pain. Although spine surgery was not among the types of operations included in the study, it’s interesting to note that 3% of the patients surveyed, ages 55-years plus, admitted opioid use and addiction.1
Older adults and the elderly are part of approximately 100 million adults in the United States (US) affected by acute or chronic pain.2 Low back pain is one of the most common causes of pain, followed by headache/ migraine pain, and neck pain. Spinal osteoarthritis, spinal stenosis, and degenerative disc disease are frequent diagnoses in our older adult and elderly populations.
In a presentation by Sullivan in 2003 about chronic pain and prescription opioid abuse and addiction in older adults, it was reported that “the prevalence of pain increases with each decade of life.” In addition, pain complaints increased 80% in adults age 65 and older.3 Furthermore, as the number of opioid prescriptions increased, so did use by older adults—but some medical studies often dismissed addiction as somewhat rare or temporary.4
The government and its agencies began to recognize and acknowledge opioid use and the potential dangers in older Americans. In 2012, a study revealed that more than 700,000 adults (ages 45 to 84) were hospitalized specifically for opioid abuse. Older adults and the elderly accounted for a five-time increase in hospitalizations for opioid abuse compared to younger Americans.5
Adults of any age taking an opioid may experience potentially dangerous drug side effects. But for older adults or senior-aged individuals, the risks are weightier. Why? Older people often take several medications simultaneously to treat different medical problems (eg, diabetes, hypertension). It can be a challenge for the patient to keep track of when to take a prescribed drug or remember if the medication was taken, which may result in unintentional doses. An opioid introduces another layer of potential risks, including respiratory depression, confusion, loss of balance, dizziness, drowsiness, nausea, and falls.
In 2015, Congress introduced a Medicare-specific bill called “Stopping Medication Abuse and Protecting Seniors Act.” Today, we see changes in how opioids are prescribed, dispensed, and monitored to prevent doctor-shopping and other ways drugs may be obtained and abused.6, 7
Managing Opioid Medications
Some adult or elderly patients live alone, in a family setting, receive home-health assistance, or reside in an assisted-living facility or other situation. In some instances, the management of the medication, including pain-relieving drug is handled by nursing or healthcare staff.
Many older adults and elderly patients are quite capable of managing their medication, doctor’s visits, and everyday life. Then there are others who need assistance. They may not realize they need help and/or may not ask. This is where a family member, friend or caregiver can help by being observant and step in to help. For example, does the patient take their medication as prescribed, but still seem to be in pain? Does he/she stumble easily or fall, complain about feeling dizzy, confused, constipated, or have other complaints?
Keep in mind that people change with age and so do their needs for medications. In managing pain and side effects, the solution may be a dose change or a different type of drug. Considering many older adults and elderly persons take multiple medications, it is a good idea to bring all prescription, OTC medication and supplements to every doctor’s visit for review. Doing so creates a good opportunity for the patient and you to talk with the doctor about health changes and new challenges.