REDUCE FALL RISK + PROMOTE HEALTHY AGING
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Major Effects of Opioid and Alcohol Use in Older Adults

Older adult examining medications

It is estimated that almost 20 percent of older adults misuse alcohol, over-the-counter medicines, and prescription drugs—most often unintentionally.  Many older adults may not realize that physiological changes as they age can render alcohol and medications harmful at doses lower than those used by younger people.  In addition, older adults often have multiple comorbidities and take numerous medications, increasing the intricacy of drug–drug interactions as well as the likelihood of substance abuse issues. 

A recent study published in Geriatric Nursing assessed the prevalence and characteristics associated with high dose opioid users among older adults. The study population included more than 250,000 AARP Medicare Supplement insured; of these, 3% (N = 7616) were identified as high dose opioid users categorized as taking >120 milligram morphine equivalents (MME) per day. 

Across the 250,000 insured in the study sample, opioid users were mostly female (69%), 70-75 years of age (27%), white (48%) and high income (43%).  In comparison, high dose opioid users were more likely to be younger, male, in poorer health, suffering from back pain, depressed, concurrently using benzodiazepines and/or sleep medications and obtained their opioids from multiple pharmacies.

Of particular note, about 50% of these high dose opioid users were prescribed benzodiazepines, with 30% receiving prescription sleep medications.  The Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain recommends avoiding these medication combinations as they increase the risk of adverse events.

Clinical Practice Implications

  • Except when an individual presents overt evidence of substance or opioid misuse, the assessment requires skillful interviewing and careful evaluation of information.  In practice settings, this includes increased awareness of patients receiving opioids who take larger doses, shorten the time between doses, and request prescription refills earlier.
  • Improve health care providers’ knowledge of appropriate prescribing of opioid medications for chronic pain management.
  • Utilize multidimensional interventions to reduce dependency on opioids by integrating mental health management (e.g., depression or anxiety) into pain management programs.

Connection to Hendrich II Fall Risk Model

Confusion, disorientation and impulsivity are collectively one of the strongest fall risk factors.  These behaviors can be caused by alcohol or opioid misuse, overuse, or abuse, which often lead to altered mental status and/or delirium.  For example, either overuse (intoxication) or sudden withdrawal from alcohol can cause delirium.  Therefore, it is recommended that a patient’s history should include an assessment of opioid and alcohol use.

References:

Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep 2016; 65(No. RR-1):1–49. DOI: http://dx.doi.org/10.15585/mmwr.rr6501e1

Musich, S., Wang, S., Slindee, L., Kraemer, S., Yeh, C., 2019. Prevalence and characteristics associated with high dose opioid users among older adults.  Geriatric Nursing. 40(1) 31-36.  doi.org/10.1016/j.gerinurse.2018.06.001

SAMHSA—Get Connected: Linking Older Adults with Resources on Medication, Alcohol, and Mental Health. HHS Pub. No. (SMA) 03-3824. Rockville, MD: Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration, 2017. 

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