Dementia is a large and growing concern. Because it cannot be reversed, understanding the best way to care for people with advanced dementia is increasingly important.
Roughly 50 percent of people with dementia who are living in nursing homes experience substantial pain. According to earlier studies, this pain often goes unnoticed by clinicians and is therefore poorly managed.
Although paracetamol is generally the first line of treatment for pain, opioids are used when paracetamol is not effective. In fact, around 40 percent of people with dementia living in nursing homes are prescribed opioids.
Opioids and Alzheimer's
Recently, researchers from three institutions investigated the impact of opioids on this population. The scientists hailed from the University of Exeter and King's College London, both in the United Kingdom, and the University of Bergen in Norway.
For their analysis, they included data from 162 Norwegian adults with advanced dementia and depression from 47 nursing homes. The findings were presented earlier this week at the Alzheimer's Association International Conference 2018, held in Chicago, IL.
The team found that side effects such as personality changes, sedation, and confusion were significantly worse in individuals taking opioids, compared with those taking a placebo.
In fact, those who were prescribed the opioid buprenorphine experienced three times the level of harmful side effects. Also, the patients taking buprenorphine were much less active.
"Pain is a symptom that can cause huge distress and it's important that we can provide relief to people with dementia. Sadly, at the moment, we're harming people when we're trying to ease their pain."
Prof. Clive Ballard, University of Exeter Medical School, U.K.
Prof. Ballard continues, "We urgently need more research in this area, and we must get this dosing right. We need to establish the best treatment pathway and examine appropriate dosing for people with dementia."
Why are side effects increased?
Prof. Ballard's team has also carried out studies on the mechanism behind the increased risk of side effects for people with dementia.
Initially, they were looking at the treatment of arthritis in a mouse model. But along the way, they noticed that mice with Alzheimer's were much more sensitive to the effects of morphine; they needed less for adequate pain relief and experienced worse adverse effects.
They discovered that this was because mice with Alzheimer's release higher levels of the body's natural opioids, such as endorphins.
The authors of both studies conclude that pain medication in people with dementia needs to be reviewed urgently. Rather than helping these individuals, it seems that, in some cases, we are impairing their ability to live life to the fullest.