Centre of Expertise in Palliative Care, Maastricht University Medical Centre, Maastricht, the Netherlands; Envida, Maastricht, the Netherlands.
Centre of Expertise in Palliative Care, Maastricht University Medical Centre, Maastricht, the Netherlands; CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands.
J Am Med Dir Assoc. 2018 Nov;19(11):974-980. doi: 10.1016/j.jamda.2018.07.009. Epub 2018 Aug 28.
Pain is a highly prevalent problem in older adults and dying patients. Opioids are the main analgesic for moderate to severe pain in these patients. Different properties of various opioids can make them more or less suitable for this specific population. We therefore aim to explore opioid prescribing behavior in a group of physicians specialized in long-term geriatric care and to identify factors that are taken into account when selecting a specific opioid for treatment of pain in older patients and patients in the dying phase.
A cross-sectional study using an online questionnaire.
All members of the Dutch Association of Elderly Care Physicians and Social Geriatricians (Verenso) on the mailing list of the weekly digital newsletter were invited to participate between November and December 2017.
Preferences in opioids for the treatment of pain in nondying and dying older patients were recorded, as were the factors that were considered for these preferences.
142 members completed the questionnaire (9%). Opioids of first choice were oxycodone (61%) for nondying and morphine (90%) for dying older patients. The second choice in both cases was fentanyl (56% for nondying and 31% in dying older patients). Personal experience was the main consideration in opioid prescribing (74%-98%). In daily practice, recommendations in guidelines are only considered by 8% to 9% and renal function by 0% to 1% of the respondents.
CONCLUSIONS/IMPLICATIONS: Oxycodone is the opioid of first choice for physicians in long-term geriatric care in the Netherlands when prescribing for nondying older patients. In contrast, morphine is preferred for dying patients. Fentanyl as a second choice is mainly reserved for situations of stable pain. Prescribers base their choices almost exclusively on personal experience and are barely influenced by guidelines. Further research should therefore focus on clinical relevance for, and implementation in, daily practice.
疼痛是老年人和临终患者中普遍存在的问题。阿片类药物是这些患者中中度至重度疼痛的主要镇痛药。不同阿片类药物的特性使其对特定人群的适用性有所不同。因此，我们旨在探讨一组专门从事长期老年护理的医生的阿片类药物处方行为，并确定在为老年患者和临终患者选择特定阿片类药物治疗疼痛时考虑的因素。
使用在线问卷进行的横断面研究。
邀请荷兰老年病医师和社会老年病学家协会（Verenso）的所有成员在 2017 年 11 月至 12 月期间参加每周数字通讯电子邮件列表的在线问卷调查。
记录了用于治疗非临终和临终老年患者疼痛的阿片类药物的偏好，以及考虑这些偏好的因素。
142 名成员完成了问卷调查（9%）。对于非临终老年患者，首选阿片类药物为羟考酮（61%），对于临终老年患者，首选阿片类药物为吗啡（90%）。在这两种情况下，第二种选择都是芬太尼（非临终老年患者为 56%，临终老年患者为 31%）。个人经验是开阿片类药物处方的主要考虑因素（74%-98%）。在日常实践中，指南中的建议仅被 8%至 9%的受访者和 0%至 1%的受访者考虑，肾功能则完全未被考虑。
结论/意义：在荷兰长期老年护理中，对于非临终老年患者，羟考酮是医生开处方时的首选阿片类药物。相比之下，吗啡是临终患者的首选。芬太尼作为二线选择主要保留用于稳定疼痛的情况。开处方者几乎完全基于个人经验做出选择，几乎不受指南的影响。因此，进一步的研究应侧重于临床相关性和在日常实践中的实施。
