The prescribing trends of opioid medications in geriatric patients at the Helen Joseph hospital pain management unit

Abstract

Background The success of pain management with opioids in geriatric patients (65 years old and older) is dependent on the mindful prescribing of opioids both prior to and during pain management by following evidenced based guidelines and acknowledging age related changes within the body. This population is vulnerable and have an increased likelihood of harm, and this includes potential, unintentional harm from prescribed medication. Aim To analyse the prescribing trends of opioids and common non-opioid analgesics in the geriatric patients at Helen Joseph Pain Management Unit (HJPMU) in Johannesburg, South Africa. Objectives To retrospectively review and collect data from prescriptions and patient-related information from the HJPMU geriatric patient files. To determine if current evidence-based pain management guidelines are being followed. To determine the probability of having opioids prescribed as a geriatric patient at HJPMU. To analyse and present both quantitative and qualitative data respectively on the prescribing of opioids and non-opioids analgesics as well as to review the presence of co-morbidities in the patients attending HJPMU. Methodology A retrospective study design was conducted to review the patient files of patients attending the HJPMU within the period of September 2020 and March 2021 within the geriatric population (> 65 years). Patient files were excluded from the review if they did not fall within the required inclusion criteria. The Regression analysis, Bivariate analysis and the 95% Confidence Interval were utilized during the study. Results The median age of the patients was 70 years old with most of the patients being females (78.04%) and having at least one co-morbidity present (86.49%) which was primarily hypertension 58.78% (n=174). Most patients (45.61%) were diagnosed with both neuropathic and nociceptive pain and were prescribed opioids (76.35%). The most common opioid and non-opioid prescribed was tramadol (76.66%) and paracetamol (80.84%). There were 256 (86.49%) patients that presented with at least one underlying condition. Hypertension was the most common co-morbidity noted 58.78% (n=174) followed by joint and bone diseases 31.42% (n=93). Despite the link between neuropathic pain and diabetes, only 16.89% of the patients had diabetes as a co-morbidity. There was a significant proportion of patients with lung disease e.g., asthma or chronic obstructive pulmonary disease (15.2%) and heart disease (14.19%). The proportion of patients who presented with two comorbidities were 29.39%. While up to 21.96% of patients presented with three or more comorbidities. There is a higher probability of opioids being prescribed in males (24.78%) than the probability of being prescribed non-opioid medication (13.11%), while females presented with a higher probability of being prescribed nonopioids (86.89%) than being prescribed opioids (75.22%). Conclusion This research demonstrated the prescribing trends noted of opioids and common nonopioid analgesics in the geriatric patients at HJPMU. Further studies are needed to establish the prescribing trends with the inclusion of nonsteroidal anti-inflammatory drug (NSAIDs) as non-opioids.