Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Rm 401, Badham Building A16, Camperdown, 2006, Sydney, NSW, Australia.
Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia.
Drugs Aging. 2024 Nov;41(11):863-871. doi: 10.1007/s40266-024-01154-5. Epub 2024 Oct 29.
Approximately one in three older adults (aged 65 years and over) experience pain, negatively impacting their quality of life. Opioid analgesics are commonly prescribed to manage pain; however, balancing the benefits and harms of these high-risk analgesics can be challenging for both healthcare professionals and patients. This is particularly true for older adults, as factors such as polypharmacy, age-related physiological changes and cognitive decline may impact upon opioid safety and efficacy. Deprescribing is the patient-centred process of reducing or discontinuing a medication that is no longer appropriate, or where the risks of continuation are deemed to outweigh the anticipated benefits. Opioid deprescribing has been proposed as a mechanism to reduce individual and societal opioid-related harm; however, to date, research has predominantly focused on the general adult population, rather than older adults. This current opinion aims to summarise the existing opioid deprescribing literature, discussing its applicability for older adults. Drawing on a non-systematic review of the literature, it identifies unique challenges and considerations for this population, highlights international initiatives to enhance opioid deprescribing in clinical practice and proposes future directions to advance the field.
大约三分之一的老年人（65 岁及以上）经历疼痛，这对他们的生活质量产生负面影响。阿片类镇痛药常用于治疗疼痛；然而，对于医疗保健专业人员和患者来说，平衡这些高风险镇痛药的益处和危害可能具有挑战性。对于老年人来说尤其如此，因为多药治疗、与年龄相关的生理变化和认知能力下降等因素可能会影响阿片类药物的安全性和疗效。药物减量是指患者为减少或停止使用不再合适的药物，或者继续使用药物的风险被认为超过预期收益而采取的以患者为中心的过程。阿片类药物减量被提议作为一种减少个体和社会阿片类药物相关伤害的机制；然而，迄今为止，研究主要集中在普通成年人群体，而不是老年人。本当前观点旨在总结现有的阿片类药物减量文献，讨论其对老年人的适用性。通过对文献的非系统性回顾，它确定了该人群的独特挑战和考虑因素，强调了提高临床实践中阿片类药物减量的国际举措，并提出了推进该领域的未来方向。
