New Opioid Rx Common, Harmful in Older Adults With Dementia

New prescription tied to 11-fold higher mortality in first 14 days versus no opioid use
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TUESDAY, July 25, 2023 (HealthDay News) -- New opioid use is common among older adults with dementia and is associated with a markedly increased excess mortality, according to a study presented at the annual Alzheimer's Association International Conference, held from July 16 to 20 in Amsterdam.

Christina Jensen-Dahm, M.D., Ph.D., from the Danish Dementia Research Centre at Copenhagen University Hospital-Rigshospitalet, and colleagues assessed whether opioids are associated with an excess mortality risk in older people with dementia. The analysis included all Danish residents aged 65 years and older diagnosed with dementia from 2008 through 2018. Those with a first opioid prescription after dementia diagnosis were age- and sex-matched (1:2) to patients without a first opioid prescription after diagnosis (31,619 and 63,235 patients, respectively).

The researchers found that 42 percent of older people with dementia redeemed a prescription for an opioid after their diagnosis of dementia. Among those filling an opioid prescription after diagnosis, one-third (33.7 percent) died within 180 days after initiating their first opioid prescription compared with 6.4 percent of the unexposed group, yielding a fourfold increased excess mortality risk (adjusted hazard ratio [aHR], 4.13). The association was more pronounced for strong opioids (aHR, 6.34) and less pronounced for weak opioids (aHR, 2.52). For those receiving transdermal fentanyl as their first prescription, two-thirds (65.3 percent) died within the first 180 days compared with 6.7 percent in the unexposed group (aHR, 8.03). Risk was greatest within the first 14 days, with 11-fold higher mortality (for all opioids; aHR, 10.95); however, there was still an increased mortality risk after 90 days (aHR, 2.36).

"The use of strong opioids has increased considerably over the past decade among older people with dementia," Jensen-Dahm said in a statement. "Our study shows the importance of careful evaluation of risk and benefits to the patient when considering initiating opioid therapy among elderly individuals with dementia."

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