New opioid use and mortality in older people with dementia

Abstract

Background

Opioid use is frequent among older people with dementia. Opioid use has been associated with excess mortality in the general population, but whether this also applies to older people with dementia is unknown.

Objective

Investigate if new opioid use compared with no use was associated with excess mortality in older people with dementia.

Methods

Matched cohort study using Danish nationwide registries including all residents (age 65+) diagnosed with dementia (including Alzheimer's disease) between 2008–2018. Exposure was defined as first opioid prescription after dementia diagnosis (1 year washout before). Persons exposed to opioids were matched with up to two unexposed persons on age and sex. Outcome was all-cause mortality within 180 days after exposure. Cox proportional hazards models compared rates of death and adjusted for potential confounders.

Results

Forty-two percent (31,619/75,471) of older people with dementia initiated a prescription for an opioid after dementia diagnosis. 31,619 exposed persons were matched to 63,235 unexposed. Among the exposed, 8540 (27%) died within 180 days after initiating their first opioid prescription compared with 3803 (6.01%) of the unexposed, yielding a 5-fold excess mortality risk (adjusted Hazard ratio: 5.06 (95% CI, 4.86–5.29)). Transdermal fentanyl use was associated with an 8-fold excess mortality risk (8.26 (7.18–9.51)).

Conclusions

Opioid use was associated with excess mortality, which may be due to the opioid, the indication or both. This observation calls for further research into the links between opioid use and excess mortality in elderly with dementia as it could have important implications for patient safety.