Researchers from Israel have uncovered a link between opioid use in older adults and dementia. The study found that elderly adults who used opioids were associated with a 40% increased risk of dementia.
Published in The American Journal of Geriatric Psychiatry, the study included data from more than 91,000 adults over age 60 without dementia who were also registered with Meuhedet Healthcare Services, a large HMO in Israel.
“Clinicians and others may want to consider that opioid exposure in those aged 75-80 increases dementia risk, and to balance the potential benefits of opioid use in old age with adverse side effects,” Stephen Z. Levine, PhD, first author of the study and professor in the Department of Community Mental Health, University of Haifa, Israel, told Medscape Medical News.
The researchers defined opioid use/exposure as opioid medication fills covering 60 days (or two prescriptions) within a 120-day interval. They found that 3.1% of the participants were exposed to opioids at an average of 73.94 years and 5.8% of the subjects developed dementia at an average age of 78.07 years. In addition, the risk of incident dementia was significantly higher in participants between the ages of 75 to 80 who were exposed to opioids compared to individuals not exposed to opioids of that same age group.
However, the researchers admit there could be other causes of dementia not included in the study, such as comorbid health conditions, vascular conditions, use of benzodiazepines (drugs used to treat anxiety) and other surgical procedures.
With those limitations in mind, Paul Christo, MD, associate professor at The Johns Hopkins University School of Medicine, who was not involved in the study, told Seasons the results of the study should be interpreted with caution.
“This is just an association that they found; it is not causation and there’s a big difference there,” he said. “This isn’t saying that opioids cause dementia; it just means the researchers found in this particular study an association between the opioid use in older adults and dementia.”
This isn’t saying that opioids cause dementia; it just means the researchers found in this particular study an association between the opioid use in older adults and dementia.
Common opioid use
According to a Morbidity and Mortality Weekly Report by the Centers for Disease Control and Prevention, an opioid prescription was filled by 19.2% of the U.S. adult population in 2018. The weekly report also revealed those aged 65 and older were about 2.6 times as likely to have an opioid prescription filled in 2018 compared to patients aged 20 to 24.
Levine continued to tell Medscape Medical News that opioids prescribed for disorders and illnesses like cancer and other pain conditions “are far more prevalent in old age than at a younger age.” He added that because there’s a high rate of opioid use, it highlights the need to consider the risks of opioid use in old age.
Even though there’s widespread and increased use of opioids, especially in older adults, it doesn’t mean opioids are bad and should not be used altogether, Christo emphasized.
“Opioids do have risks, and certainly overdose and death is a risk, there’s no question about it with opioid use,” he said. “But with judicious use of opioids for legitimate purposes, they’re really helpful. Over the last several years, we’ve seen a lot of patients unfortunately who’ve been weaned from opioids and where the physicians stopped opioid prescribing altogether. That has led to a lot of pain and sort of increased pain and harm for those people.”
With 45-85% of older adults living with chronic pain, this common symptom is nevertheless often underrecognized and undertreated.
“I hope this doesn’t lead to patients and then physicians to underprescribe opioids because we’re already talking about a population that’s at risk and that typically has chronic pain,” he said. “So, while I think this study is important to discuss, I hope it doesn’t lead to underprescribing of opioids.”
What this means for caregivers
Although the researchers found an association between opioids and dementia, Christo said families, caregivers and older adults should not stop opioid use without speaking to their doctor first.
Caregivers and older adults should not stop opioid use without speaking to their doctor first.
“What we don’t want to have happen is for patients to be withdrawn from opioids if they’re older adults and they are doing well on them,” Christo said.
In addition, if you have any concerns regarding current opioid use or future use for a loved one, caregivers and older adults should still speak with a professional health care provider.
Ask them about the risks of opioids, benefits, what kind of opioid will be used for treatment, how long will the individual have to use opioids, and any other questions of concern.