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Older Hospitalized Patients Respond Well to Non-Opioid Alternatives for Pain

June 22, 2017
In one of the first studies to consider opioid use in hospitalized elderly patients who are admitted for reasons other than pain, most will respond well to alternative methods of pain relief when it is offered.

With Sutapa Maiti, MD

Findings on opiate use in older hospitalized patients and how its use correlated with outcomes, was the focus of a presentation at the American Geriatrics Society 2017 Annual Scientific Meeting, from May 18-20, 2017, in San Antonio, Texas.

“Our study is looking at the older hospitalized patient on the medicine service. There are a lot of people admitted for arthritis flare-ups, congestive heart failure, and non-operable fractures,” Sutapa Maiti, MD, a geriatric fellow at Northwell Health, told Practical Pain Management.

In first study of hospitalized elderly, they should be encouraged to try non-drug forms of pain relief first.

She and her colleagues analyzed a year’s worth of data on patient’s admitted to Northwell Health, a large New York metropolitan-area health provider, comprising more than 10,000 patients, age 65 years and older, who were hospitalized for chronic illnesses like heart disease, chronic obstructive pulmonary disease, diabetes, and pneumonia.1

According to their presentation, "Opiate Prescribing in Hospitalized Older Adults: Patterns and Outcomes,” close to 30% of geriatric patients received opiates during their hospital stay.1 Of those receiving opiates, a large majority (84%) were first-time users.1

“While there are many studies on opiate abuse and overdose, they looked at patients in the emergency rooms, or in the outpatient setting,” said Dr. Maiti, “No one has really been looking at the place where people are first exposed to opiates, which is, in our opinion, the medicine in-service, when they get admitted for other comorbidities.”

Further, the study found that opiate use correlated with negative health outcomes. Opiate users were more likely to be restrained and unable to receive food or fluids by mouth.1 They were more likely to be on bed rest, have indwelling bladder catheters, and receive potentially inappropriate medications such as benzodiazepines and diphenhydramine.1

“We are finding that people, once exposed to opiates, are more likely to get other medications to help control their symptoms that have effects on perception and things like balance, so we're worried about falls,” said Dr. Maiti.

In addition, the data showed that the opiate recipients required more healthcare resources. Their length of stay was approximately 50% longer than those who did not receive opiates (6 days versus 4 days, p<0.0001). Opiate recipients were also less likely to be released directly home and more often readmitted within 30 days (21.88 vs. 19.53, p=0.0063).1

A patient’s age, race, gender, or ethnicity was not found to significantly link to opiate use. “We actually found that those who were married were less likely to receive opiates,” Dr. Maiti told Practical Pain Management. She speculated that this pattern could reflect the social factor, in that “If you have good family support, maybe that influences how you handle the pain or the comfort you get from your family as you go through a health crisis.”

Dr. Maiti told Practical Pain Management that she believes it is important for clinicians to open a true dialogue with patients about the implications of opiate use and to actively explore viable alternatives, which might include Tai Chi, physical exercise, acupuncture, and counseling, among others.

“When approaching the topic of pain with your patient, make it a discussion,” Dr. Maiti said, Talk about what they're using, talk about all the drugs that they have prescriptions for, and those they don’t, even the medicinals they may not have written down, and start counseling them, she said.

“Start building a relationship with each patient because opiates are a reality, some patients will need that level of pain relief; however, it is essential, even critical, to explore what can we do for patients before we cross to the point of prescribing an opiate,” Dr. Maiti said.

Last updated on: December 14, 2017
Continue Reading:
Perioperative Pain Management in the Opioid-tolerant Elderly Patient: Case Challenge
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