The Use of Opioids and Antipsychotics in Elderly with Dementia: Have Opioids Replaced Antipsychotics in Treating Behavioral Symptoms in Dementia?
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The Use of Opioids and Antipsychotics in Elderly with Dementia : Have Opioids Replaced Antipsychotics in Treating Behavioral Symptoms in Dementia? / Jensen-Dahm, Christina; Christensen, Ane Nørgaard; Gasse, Christiane; Waldemar, Gunhild.
I: Journal of Alzheimer's Disease, Bind 73, Nr. 1, 01.2020, s. 259-267.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - The Use of Opioids and Antipsychotics in Elderly with Dementia
T2 - Have Opioids Replaced Antipsychotics in Treating Behavioral Symptoms in Dementia?
AU - Jensen-Dahm, Christina
AU - Christensen, Ane Nørgaard
AU - Gasse, Christiane
AU - Waldemar, Gunhild
PY - 2020/1
Y1 - 2020/1
N2 - Background: Opioids are used with increasing frequency. Elderly with dementia are prescribed opioids more frequent than elderly without. One possible explanation is that opioids may be used not only to treat pain but also behavioral symptoms. Objective: To test the hypothesis that strong opioid use, especially transdermal formulations, had increased, especially in elderly with dementia, in parallel with a decrease in antipsychotic use. Methods: Population-based cross-sectional study conducted using nationwide Danish registers with data on Denmark's entire elderly population age ≥65 (2000: n=802,106; 2015: n=1,056,476). The registers were used to identify elderly with and without dementia and filled prescriptions for opioids and antipsychotics. Annual prevalence of opioid and antipsychotic use from 2000-2015 was calculated. Results: Prevalence of opioid use increased by 35% (24.2 to 32.5%) among elderly with dementia and by 13% among elderly without (14.9 to 16.8%) from 2000-2015. The disproportionate increase in opioid use among elderly with dementia was mainly driven by an increase in strong opioids (dementia: 11.7 to 23.1%; without dementia: 5.9 to 7.4%). Use of antipsychotics decreased during the same period (dementia: 31.3 to 19.3%; no dementia: 4.5 to 2.7%). Conclusion: From 2000-2015, use of opioids among the elderly increased with a disproportionately higher increase among elderly with dementia. The parallel decrease in the use of antipsychotics may suggest that opioids to some extent have replaced antipsychotics in managing behavioral symptoms, despite safety concerns and lack of evidence for effect of opioids. Future research should focus on potential risks associated with increased opioid use.
AB - Background: Opioids are used with increasing frequency. Elderly with dementia are prescribed opioids more frequent than elderly without. One possible explanation is that opioids may be used not only to treat pain but also behavioral symptoms. Objective: To test the hypothesis that strong opioid use, especially transdermal formulations, had increased, especially in elderly with dementia, in parallel with a decrease in antipsychotic use. Methods: Population-based cross-sectional study conducted using nationwide Danish registers with data on Denmark's entire elderly population age ≥65 (2000: n=802,106; 2015: n=1,056,476). The registers were used to identify elderly with and without dementia and filled prescriptions for opioids and antipsychotics. Annual prevalence of opioid and antipsychotic use from 2000-2015 was calculated. Results: Prevalence of opioid use increased by 35% (24.2 to 32.5%) among elderly with dementia and by 13% among elderly without (14.9 to 16.8%) from 2000-2015. The disproportionate increase in opioid use among elderly with dementia was mainly driven by an increase in strong opioids (dementia: 11.7 to 23.1%; without dementia: 5.9 to 7.4%). Use of antipsychotics decreased during the same period (dementia: 31.3 to 19.3%; no dementia: 4.5 to 2.7%). Conclusion: From 2000-2015, use of opioids among the elderly increased with a disproportionately higher increase among elderly with dementia. The parallel decrease in the use of antipsychotics may suggest that opioids to some extent have replaced antipsychotics in managing behavioral symptoms, despite safety concerns and lack of evidence for effect of opioids. Future research should focus on potential risks associated with increased opioid use.
KW - Antipsychotic
KW - behavioral symptoms
KW - dementia
KW - drug use
KW - opioid
KW - pain
UR - http://www.scopus.com/inward/record.url?scp=85077790331&partnerID=8YFLogxK
U2 - 10.3233/JAD-190787
DO - 10.3233/JAD-190787
M3 - Journal article
C2 - 31771062
AN - SCOPUS:85077790331
VL - 73
SP - 259
EP - 267
JO - Journal of Alzheimer's Disease
JF - Journal of Alzheimer's Disease
SN - 1387-2877
IS - 1
ER -
ID: 249527914