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Older adults who start taking opioids after a dementia diagnosis are 11 times more likely to die within the first two weeks of taking the drugs, new research shows.
One-third of patients with dementia who were prescribed opioids died within 180 days of starting their first opioid prescription, while just 6.4% of the dementia patients not exposed to opioids died within that time frame, according to the study by researchers at the Danish Dementia Research Center in Copenhagen.
The study, released Tuesday at the Alzheimer’s Association International Conference in Amsterdam, tracked everyone in Denmark age 65 and older who was diagnosed with dementia over an 11-year period ending in December 2018. More than 75,000 people were studied, and 42% of them received an opioid prescription after their dementia diagnosis.
Opioids’ known side effects include sedation, confusion, inadequate breathing and falls, Dr. Christina Jensen-Dahm, a researcher at the Danish dementia center and lead author of the study, said in a statement. “Older adults with dementia have a severe brain disorder and are often frail,” Jensen-Dahm said. “We suspect this is why they cannot tolerate opioids,” although more research is needed to understand the issue.
The use of “strong opioids,” such as oxycodone and fentanyl, has increased considerably in recent years among older people with dementia, Jensen-Dahm said. Other recent studies have found an increase in opioid prescriptions for older adults with dementia over the past 20 years or so, while prescribing of antipsychotic medications for these patients has tapered off — suggesting that opioids to some extent replaced antipsychotics as a method for managing the behavioral symptoms of dementia, researchers say.
Among more than 35,000 residents living with dementia in Veterans Health Administration nursing homes, for example, antipsychotic prescriptions declined between 2009 and 2018, while opioid prescriptions climbed to more than 41%, from 33%, according to a study published last year in the American Journal of Psychiatry.
Those trends coincide with a years-long regulatory effort to rein in the use of antipsychotic medications in nursing homes. The U.S. Food and Drug Administration has established black-box warnings related to use of certain antipsychotic medications in people with dementia, due to concerns about increased risk of death.
In the Danish study released Tuesday, which included people living in nursing homes as well as those living at home, strong opioids were linked with a sixfold increase in risk of death. Among patients who used fentanyl patches as their first opioid prescription, 64% died within 180 days, the researchers found.
“Opioids are very powerful drugs, and while we need to see additional research in more diverse populations, these initial findings indicate they may put older adults with dementia at much higher risk of death,” Dr. Nicole Purcell, a neurologist and senior director of clinical practice at the Alzheimer’s Association, said in a statement. While pain shouldn’t go undiagnosed or untreated, Purcell said, the research underscores the need for discussion between patients, families and doctors, and careful monitoring of the patient.
In updated opioid prescribing guidelines issued late last year, the Centers for Disease Control and Prevention said doctors should take additional steps to minimize the risks of any opioids prescribed for people 65 and older, including risk assessment for falls and monitoring for cognitive impairment.
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