LOUISVILLE According to 2016 data from the Substance Abuse and Mental Health Services Administration, more than 500,000 Medicare Part D beneficiaries take opioids, with the average dose far exceeding the recommended amount. “According to SAMSA, opioid misuse among older adults can lead to severe health risks such as breathing complications, confusion, drug interaction problems, and increased risk of falls,” says Anna Faul, PhD, the Trager Institute’s executive director.
“Opioids can be safe for older adult patients,” says Christin Furman, MD, the Trager Institute’s medical director. “The key is to start low and go slow. Due to the possible health complications, primary care providers need to be sure the dosage is correct for their patient, and they need to check for any possible interactions the opioids might have with other medications.”
“With the majority of older adults taking at least one prescription medication daily, the risk of adverse drug-drug integrations and drug-disease interactions increases,” says Faul.
To reduce the risk of opioid misuse in older adults, the Trager Institute has been working with individuals in rural Kentucky who are involved in the Trager Institute’s Flourish Program, which is designed to deliver interdisciplinary care coordination to those with chronic conditions. Of the 173 patients who have received services, medication management issues related to opioid prescriptions and interactions with other medications were a factor with more than 90 patients. Medication safety also proved to be a problem, with family members or caregivers taking opioids from patients in at least 10 percent of cases.
The Trager Institute recently received supplemental federal funding to their Geriatrics Workforce Enhancement Program grant, specifically to expand work in Bullitt, Henry, Oldham, Shelby, Spencer, and Trimble counties related to opioids and older adults. Services also will be offered in Jefferson, Barren, Metcalf, and Hart counties.
“This additional funding will allow us to dramatically increase our ability to screen for potential opioid misuse and to educate patients, students, and practitioners on best practices for pain management for older adults,” says Faul.
Specific new screening and trainings include:
Increasing ability to predict aberrant medication-related behavior with the program’s Flourish Index, the Trager Institute’s comprehensive geriatric assessment tool.
Through trainings offered by a psychiatric nurse practitioner funded by this grant, students will receive increased training on specific opioid issues, the risk of opioid misuse for older adults, and alternative pain medication options.
Creation of a resource guide for practitioners about opioids and older adults, to include information on appropriate dosage for opioids, possible drug interactions, as well as fact sheets and informational videos on alternative pain management strategies.
New training program for mental health clinicians on how to identify and treat opioid related substance abuse among older adults.
In addition to these expanded efforts to address opioid misuse among older adults, the Trager Institute has launched a Project ECHO on the care of older adults that will include pain management training didactics for primary care providers and CNAs in nursing homes. These didactics use telementoring to build capacity at the local level through case-based learning. The sessions meet on the 1st and 3rd Friday of each month and will be offering CMEs in the near future.
“In order to manage older adult patients’ pain effectively, it is essential for primary care providers to understand the best practices for prescribing and monitoring opioids, including the use of screening tools to identify those at high risk of opioid addiction, conducting pain contracts, and prescribing alternative pain management strategies,” says Furman.
PHOTO PROVIDED BY UOFL TRAGER INSTITUTE