Pain treatment in the elderly is an important challenge in today’s time due to increasing numbers of senior citizens, higher incidence of pain, and the greater susceptibility to adverse effects of pain medication in this population. Opioids, as a class, may be less likely to cause organ toxicity than NSAIDs (i.e. GI bleeds) in senior citizens. According to these guidelines, opioid therapy for elderly patients may be safe over the long term, but can be dangerous when starting or increasing a dose.
When it comes to risks of opioid use in the elderly, the primary concerns are constipation, overdose, over sedation and falls. To minimize these effects, the following precautions are recommended in elderly patients: lower starting doses, slower titration, longer dosing intervals, more frequent monitoring, and discontinuing (by tapering) benzodiazepine use when possible.
Practical recommendations for opioid prescription in the elderly include meticulous review of indication for opioid use not only initially, but also at regular intervals thereafter. A policy of careful titration should be followed, with conservative choice of dosage on starting. Dosing intervals may need to be lengthened subsequently. It is very important in assessing concurrent or undisclosed use of medications, such as over-the-counter NSAIDs, other opioids, and benzodiazepines or other sedatives (including alcohol), that place patients at higher risk for morbidity or mortality. Assessment of the patient’s ability to reliably self-administer should also be considered, especially if signs of cognitive impairment are apparent and he or she is still living independently.
As with all patients, including senior citizens, it is important that you disclose all your prescription and over-the-counter medications (including alternative medications) and any alcohol consumption to your doctor.
Before prescribing an opioid, an environmental assessment for potential addiction/diversion risk should be conducted. The elderly may be a target for drug theft, etc. Proper storage and limited discussion surrounding the opioid is prudent.