Abstract
Objectives
Pain is a highly prevalent problem in older adults and dying patients. Opioids are
the main analgesic for moderate to severe pain in these patients. Different properties
of various opioids can make them more or less suitable for this specific population.
We therefore aim to explore opioid prescribing behavior in a group of physicians specialized
in long-term geriatric care and to identify factors that are taken into account when
selecting a specific opioid for treatment of pain in older patients and patients in
the dying phase.
Design
A cross-sectional study using an online questionnaire.
Setting and Participants
All members of the Dutch Association of Elderly Care Physicians and Social Geriatricians
(Verenso) on the mailing list of the weekly digital newsletter were invited to participate
between November and December 2017.
Measures
Preferences in opioids for the treatment of pain in nondying and dying older patients
were recorded, as were the factors that were considered for these preferences.
Results
142 members completed the questionnaire (9%). Opioids of first choice were oxycodone
(61%) for nondying and morphine (90%) for dying older patients. The second choice
in both cases was fentanyl (56% for nondying and 31% in dying older patients). Personal
experience was the main consideration in opioid prescribing (74%-98%). In daily practice,
recommendations in guidelines are only considered by 8% to 9% and renal function by
0% to 1% of the respondents.
Conclusions/Implications
Oxycodone is the opioid of first choice for physicians in long-term geriatric care
in the Netherlands when prescribing for nondying older patients. In contrast, morphine
is preferred for dying patients. Fentanyl as a second choice is mainly reserved for
situations of stable pain. Prescribers base their choices almost exclusively on personal
experience and are barely influenced by guidelines. Further research should therefore
focus on clinical relevance for, and implementation in, daily practice.
Keywords
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Article info
Publication history
Published online: August 28, 2018
Footnotes
Daisy J.A. Janssen has received speakers fee from Novartis, AstraZeneca, Boehringer Ingelheim, and GlaxoSmithKline. She has received consultancy fee from Mayne Pharma. All other authors have no conflict of interest.
This work was supported by funding from The Netherlands Organization for Health Research and Development (ZonMw), grant number 844001314, The Hague, The Netherlands, and Envida, Maastricht, the Netherlands.
Identification
Copyright
© 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
