Dementia patients who take opioids face ‘worrisome’ death risk, new study finds

Opioid use could put dementia patients at a higher risk of death, particularly in the first two weeks after starting a medication, according to new research revealed on Tuesday at the Alzheimer’s Association International Conference (AAIC) in Amsterdam.

Among all patients age 65 and older who were diagnosed with Alzheimer’s disease in Denmark and who took an opioid over a 10-year period, a third of them died within 180 days after starting the medication, researchers found, according to a press release from the Alzheimer’s Association.

The death risk was around five times higher than for those who did not take opioids — but it was 11 times higher within the first two weeks.

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The risk was even higher among those who used fentanyl patches, with nearly two-thirds of those patients dying within 180 days, the Alzheimer’s Association reported.

When looking at strong opioids — morphine, oxycodone, ketobemidone, hydromorphone, pethidine, buprenorphine and fentanyl — the risk of death was six times higher than dementia patients who did not take the medications.

“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,” Dr. Christina Jensen-Dahm of the Neurology Department at Copenhagen University Hospital in Denmark said in the press release. 

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“The use of strong opioids has increased considerably over the past decade among older people with dementia,” she continued.

“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.”

Given the heightened mortality risk, experts advise caution when prescribing opioids to dementia patients, but also emphasized the need for safe pain management in this vulnerable population.

“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,” Dr. Nicole Purcell, neurologist and Alzheimer’s Association senior director of clinical practice, said in the Alzheimer’s Association press release. 

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“These new findings further emphasize the need for discussion between the patient, family and physician,” Purcell continued. 

“Decisions about prescribing pain medication should be thought through carefully, and, if used, there needs to be careful monitoring of the patient,” she also said.

Although more research is needed to determine why older adults with dementia face a higher death risk with opioid use, Jensen-Dahm said they may be less equipped to handle the potentially serious side effects.

“Opioids are known to have significant side effects, including sedation, confusion, respiratory depression and falls,” she said. 

“Older adults with dementia have a severe brain disorder and are often frail,” Jensen-Dahm added. 

“We suspect this is why they cannot tolerate opioids, but we do not know for certain and need to do more research to answer these questions.”

Medications used to treat psychiatric conditions, known as atypical antipsychotics, have also been found to increase the mortality risk for older dementia patients, the press release stated.