Understanding opioid analgesic prescribing and cognitive adverse effects in older adults: a mixed methods study

Pask, Sophie

Abstract

Background: Pain is prevalent in older adults (≥65). Opioids are used to manage moderate to severe pain, but older populations may be more at risk of adverse effects. Opioid-induced cognitive impairment can be distressing but evidence to inform our understanding is limited.
Aim: To understand opioid use in the pain management of older adults, how opioids impact older adults’ cognition, and explore their experiences, perspectives, concerns, and information and support needs regarding these.
Methods: This study comprised two key components: (1) a systematic review to synthesise existing evidence on the impact of opioids on older adults’ cognition and the assessments used to detect changes in cognition, and (2) a mixed methods study; comprising a cross-sectional survey and case note review to investigate opioid prescribing in community-dwelling frail older adults with chronic pain and their impact on cognition, and in-depth interviews to explore their experiences, perspectives and concerns of these aspects. Patient and Public Involvement was used to inform the mixed methods study, and refine study materials and interview topic guide.
Results: Limited evidence identified in the systematic review indicated that impairments were observed with higher mean opioid doses, and memory, attention, language and psychomotor function were worsened. Screening tools are rarely discriminatory enough to detect changes, and neuropsychological assessments are not feasible in clinical practice.
247 participants were recruited to the cross-sectional survey when attending an Integrated Care Centre for an assessment, and a case note review was conducted where medical record data was present. Qualitative interviews were conducted with a subset of 18 patient participants and their carers. A high prevalence of pain (>50%) despite treatment was observed. 51.8% were prescribed an opioid over the past year, with pain severity and number of medications being significantly associated with increased odds of an opioid prescription. The presence of opioid prescriptions were significantly associated with poorer health-related quality of life. Insurmountable work was required to manage chronic pain and cognitive adverse effects that impacted everyday life and emotional and psychological wellbeing. The challenges with accessing support led to a reduced sense of safety and security, and increased feelings of despair and isolation.
Conclusions: Pain remains a prominent issue for frail older adults despite treatment. Opioids are commonly prescribed and opioid-induced cognitive impairment is bothersome to older adults and their informal caregivers, and create insurmountable work. The importance of caring was essential to ensuring that patients felt safe and secure. Simple changes to patient-provider communication could improve pain management (e.g. provision of clear information, guided discussions to identify common adverse effects, ongoing support, and reviews).

Citation

Pask, S. Understanding opioid analgesic prescribing and cognitive adverse effects in older adults: a mixed methods study. (Thesis). Hull York Medical School. https://hull-repository.worktribe.com/output/4424999

• Thesis Type: Thesis
• Deposit Date: Oct 25, 2023
• Publicly Available Date: Nov 4, 2024
• Keywords: Medicine
• Public URL: https://hull-repository.worktribe.com/output/4424999
• Additional Information: Hull York Medical School; University of Hull and University of York
• Award Date: Oct 1, 2022