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AAIC 2023 | Marked excessive mortality risk associated with new opioid use in older people with dementia
In a previous study focused on elderly individuals with dementia, the use of opioids was found to be quite frequent: higher than in the elderly population without dementia. To investigate the consequences of this, Christina Jensen-Dahm, MD, PhD, Danish Dementia Research Centre, Copenhagen University Hospital, Copenhagen, Denmark, and her team conducted a matched cohort study of all Danish residents aged 65 year or older, diagnosed with dementia over a 10-year period. Mortality rates were compared between those receiving an opioid prescription after their diagnosis of dementia (exposed) and those who did not (unexposed). The study revealed an overall four-fold increased excess mortality risk in those exposed to opioids, with an even higher risk (11-fold) observed in the first two weeks after starting opioid use. Among different types of opioids, transdermal patches were associated with the most significant harm. Consequently, clinicians must carefully weigh the risks and benefits of initiating opioid treatment, exploring alternative options, and thoroughly discussing potential risks with patients before considering opioid therapy. This interview took place at the Alzheimer’s Association International Conference® (AAIC) 2023 in Amsterdam, Netherlands.
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Transcript (edited for clarity)
So the background is that previously we’ve done some studies looking at use of opioids in elderly with dementia. What we found was that the opioid use was quite frequent in elderly with dementia and also higher than in elderly without dementia. So we wanted to look at did this have any adverse consequences? And we therefore conducted a cohort study where we compared mortality risk in elderly with dementia where some of them were started on an opioid after their diagnosis and others were not using opioids...
So the background is that previously we’ve done some studies looking at use of opioids in elderly with dementia. What we found was that the opioid use was quite frequent in elderly with dementia and also higher than in elderly without dementia. So we wanted to look at did this have any adverse consequences? And we therefore conducted a cohort study where we compared mortality risk in elderly with dementia where some of them were started on an opioid after their diagnosis and others were not using opioids. So that’s the overall study design and what we found were that there was overall an four-fold excess mortality risk in those who began treatment with an opioid and this mortality risk was particularly pronounced in the first two weeks where there was an 11-fold increased mortality risk.
So those are some of the major findings. When we also looked into different types of opioids, we found that particularly the transdermal patches such as fentanyl and buprenorphine were particularly harmful, whereas fentanyl were associated with an eight-fold increased mortality risk.
Well, I mean, we know from the general population that opioids are associated with increased mortality risk, but what we see is when we compare it to other studies, that this risk seems to be greater in elderly with dementia and what we think is that these are people who have brain that’s diseased and we’ve seen with other drugs such as antipsychotics, that they have an increased mortality risk. And we think it’s because their brain disorder that they are at an increased risk.
It means that you need to consider very carefully the risk and benefits if you consider starting an opioid. So it also means that when a patient with dementia is in pain, you need to sort of make sure that you explore all of the options before considering an opioid and if you consider an opioid, you need to discuss it carefully with both the patient and the caregiver. What are the risks and benefits? Because some patients will definitely still be in need of opioid medications, whereas in others you may need to think otherwise, think of an alternative treatment.