Management of drug-drug interactions: considerations for special populations--focus on opioid use in the elderly and long term care.

Elderly patients and residents in long term care facilities requiring pain medication often have multiple pharmacologic and physiologic factors that can impact the choice of analgesic. One particular problem with prescribing opioids to the elderly and long term care residents is that opioid safety and efficacy have not been well studied in these populations, and it may be difficult to predict how these patients will respond to opioid treatment. As people age, numerous physiological changes occur, which may affect opioid pharmacokinetics and the potential for drug-drug interactions (DDIs). Long term care residents include the elderly but also include many younger patients who require assistance for a variety of reasons, such as physical or mental disability. Many elderly and long term care patients have cognitive deficits that impede communication about their pain, thus making detection of opioid DDIs more difficult. Knowledge of the patient's medical history and current prescriptions can help guide the pain management team in the selection of treatment, help minimize the risk of DDIs, and provide these patients with the pain relief they require. There are several practice management recommendations for opioid therapy in the elderly and long term care residents, with the goal of optimizing analgesia while avoiding adverse events and drug interactions.