Opioid Prescribing Behavior in Long-Term Geriatric Care in the Netherlands

Objectives: 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.

Design: A cross-sectional study using an online questionnaire.

Setting and participants: 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.

Measures: 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.

Results: 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.