New opioid use in dementia patients associated with ‘markedly increased’ mortality risk

New opioid use significantly increases the risk of death in older adults with dementia, according to research reported at the Alzheimer’s Association International Conference.

“In our study, starting on an opioid after getting a dementia diagnosis was frequent and associated with a markedly increased risk of death, which is worrisome,” Christina Jensen-Dahm, MD, PhD, of the neurology department at the Danish Dementia Research Centre at at Rigshospitalet in Denmark, said in a press release. “The use of strong opioids has increased considerably over the past decade among older people with dementia. 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.”

Jensen-Dahm and colleagues conducted a matched cohort study of 75,471 patients with dementia aged 65 years and older living in Denmark who were diagnosed between Jan. 1, 2008, and Dec. 31, 2018. The researchers followed the participants for 180 days after their first opioid prescription.

A total of 42% of the study population redeemed a prescription for an opioid at a pharmacy within the study period. The researchers reported that 33.1% of participants died within 180 days after taking their first opioid prescription, compared with 6.4% who never took an opioid. After adjusting for potential differences between the groups, the researchers determined that this represented a fourfold increased mortality risk

Mortality was increased sixfold with the use of strong opioids such as morphine, oxycodone, ketobemidone, hydromorphone, pethidine, buprenorphine and fentanyl. Mortality for all opioids was increased elevenfold in the first 14 days.

Of those who used fentanyl patches as their first opioid prescription, 64.4% died within the first 180 days compared with 6.4% of unexposed participants.

“Pain should not go undiagnosed or untreated, in particular in people living with dementia who may not be able to effectively articulate the location and severity of the pain,” Nicole Purcell, DO, MS, neurologist and Alzheimer’s Association senior director of clinical practice, said in the press release. “These new findings further emphasize the need for discussion between the patient, family and physician. Decisions about prescribing pain medication should be thought through carefully, and, if used, there needs to be careful monitoring of the patient.”