Opioid Prescribing in the Elderly: A Systematic Review

Area of Science:

• Geriatric Medicine
• Pharmacology
• Pain Management

Background:

• Opioid analgesics are frequently prescribed for persistent pain in elderly patients.
• Evidence-based guidelines for safe and effective opioid use in this population are limited.
• Older adults may experience unique pharmacokinetic and pharmacodynamic changes affecting opioid response.

Purpose of the Study:

• To systematically review and characterize the existing literature on therapeutic opioid use in individuals aged 65 years and older.
• To evaluate the efficacy and safety profiles of opioids in the elderly population.
• To identify common pain etiologies and adverse events associated with opioid therapy in older adults.

Main Methods:

• A comprehensive literature search was conducted in EMBASE and MEDLINE from 1990 to September 2018.
• Included studies were observational, population-based cohort, retrospective analyses, and controlled trials focusing on persistent pain management in patients aged 65+.
• Two independent reviewers screened 827 citations, with 39 articles ultimately included in the systematic review.

Main Results:

• Musculoskeletal conditions were the most common reason for opioid prescriptions (50%).
• Central nervous system (CNS) adverse effects (41%) and falls/fractures (39%) were the most frequently reported adverse events.
• The review included a mix of study designs: 17 observational, 7 cohort, 10 retrospective, and 4 controlled trials.

Conclusions:

• Central nervous system adverse effects are a significant concern with opioid use in the elderly.
• Current evidence is insufficient to establish clear dose-related effects on opioid efficacy and safety in this demographic.
• Higher-quality research is necessary to inform clinical practice regarding opioid management in older patients.