Fentanyl use in older adults

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In 2012, a study revealed that more than 700,000 adults (ages 45 to 84) were hospitalized specifically for opioid abuse. Older adults and the elderly accounted for a five-time increase in hospitalizations for opioid abuse compared to younger americans. Adults of any age taking an opioid may experience potentially dangerous drug side effects. Fentanyl in the iv form, such as during surgery, is often given to patients who are not opioid tolerant but those circumstances are much different considering it is a short-acting form and the patient is monitored closely. It is a synthetic, pure mu-opioid receptor agonist with multiple mechanisms of action. 18 methadone has qualities that are favorable for use in older adults, as it is safe in most patients with kidney or hepatic impairment, has no active metabolites, may be less constipating, is available in a variety of formulations, and is low cost. Alcohol use disorder most admissions to substance use treatment centers in this age group relate to alcohol. 2 one study documented a 107 increase in alcohol use disorder among adults aged 65 years and older from 2001 to 2013. And may maintain opioid use older adults have many painful conditions, among these are arthritis and other musculoskeletal conditions.   older adults can take opioids but may need to be started at lower dosages and titrated up more slowly. Creatinine clearance is a key consideration in the choice of which opioid to use. Potential harms of opioid therapy disproportionally affect older patients. This study aims to provide information on trends, nature and duration of opioid prescribing to older adults, in primary care and to explore differences between older patients from different ages. While opioid use disorders are more common in younger patients, prevalence among the elderly is growing, and misuse poses unique risks in the geriatric population. From 19, the number of opioid prescriptions provided to older patients increased 9-fold.   transdermal buprenorphine and fentanyl are both recommended opioids for use in older nondialysis chronic kidney disease patients3, 29, 30 and have been studied head to head in a cancer population with and without renal impairment. 11 both opioids are metabolized by the liver and converted to clinically insignificant metabolites. 27, 35 absorption of transdermal buprenorphine and fentanyl appears unaltered in older adults. Because older adults with nondialysis chronic kidney disease are at increased risk for adverse events, vigilant monitoring of opioid prescription is critical. Lastly, collaboration among an interprofessional clinical team can ensure safe prescription of opioids in older adults with nondialysis chronic kidney disease.

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