A systematic review of the evidence for the efficacy of opioids for chronic non-cancer pain in community-dwelling older adults
| Autor: | Anne P. F. Wand, Michael O'Brien |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Aging
medicine.medical_specialty Activities of daily living MEDLINE 03 medical and health sciences 0302 clinical medicine Humans Medicine 030212 general & internal medicine Medical prescription Depression (differential diagnoses) Aged Evidence-Based Medicine business.industry Chronic pain General Medicine Social engagement medicine.disease Analgesics Opioid Treatment Outcome Opioid Physical therapy Independent Living Chronic Pain Geriatrics and Gerontology business Older people 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Age and Ageing. 49:175-183 |
| ISSN: | 1468-2834 0002-0729 |
| Popis: | Introduction the ageing global population and concomitant increase in the use of opioid analgesia have highlighted the need to evaluate the effectiveness of opioids for chronic pain in older people. Methods a systematic review of the evidence for the efficacy of opioids for chronic non-cancer pain in community-dwelling people aged 65 years or more was conducted using PRISMA guidelines. The databases MEDLINE, EMBASE, Pubmed and PsychINFO were searched. The quality of studies was assessed. Secondary aims were to assess correlates of opioid use and the decision-making processes of prescribers. Results seven studies were identified of low to high quality. The majority of older people experienced ongoing pain despite continuing opioid therapy. There were mixed results regarding benefits of opioids in terms of activities of daily living and social engagement. In nursing home residents, opioid use at baseline was associated with severe pain, severe impairment in activities of daily living and a diagnosis of depression. Fear of causing harm to older people was common amongst opioid prescribers, limiting prescription. Facilitators of opioid prescription included educational interventions and access to an evidence base for opioid use. Conclusion there is limited evidence supporting the use of long-term opioid use in older people for chronic non-cancer pain and a lack of trials in this age group. Age-specific guidelines are required addressing initial assessment, indications, monitoring and de-prescribing. |
| Databáze: | OpenAIRE |
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